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1.
Occup Med (Lond) ; 74(3): 230-234, 2024 05 09.
Artigo em Inglês | MEDLINE | ID: mdl-38606796

RESUMO

BACKGROUND: The utility of the occupational medicine diploma in the UK is yet to be explored. The NHS 'Growing Occupational Health (OH) and Wellbeing' programme provides opportunities for diplomates to increase their OH work. AIMS: To assess what proportion of diplomates carry out OH work, the type of work being undertaken, to identify obstacles impeding OH work, to capture their interest in future work opportunities and what additional support they require. METHODS: A link to an online questionnaire was sent to diplomates via several professional bodies; we estimate that 2428 diplomates received this. The survey was open from 24 March to 31 May 2022. RESULTS: Replies were received from 310/2428 (13%) diplomates. Fifty-two per cent of respondents were males and 35% were female. Respondents were diverse in terms of age and geographical region. Main employment settings: 13% primary care, 43% secondary care, 31% private sector, 24% public sector and 20% self-employed. Seventy-two per cent of diplomates had undertaken OH clinical work since completion of their diploma, and 90% of those were undertaking OH clinical work at the time of the survey. Specific obstacles to accessing OH work highlighted included existing workload constraints, lack of employment opportunities with OH providers and lack of time. CONCLUSIONS: Many (126/310; 41%) respondents had considered increasing their OH work in the previous 12 months. Increasing mentorship from senior OH clinicians to diplomates was suggested by 4% of respondents to enhance the utility of diplomates.


Assuntos
Medicina do Trabalho , Humanos , Inquéritos e Questionários , Feminino , Masculino , Adulto , Pessoa de Meia-Idade , Reino Unido , Medicina Estatal
2.
J Public Health (Oxf) ; 45(2): e285-e295, 2023 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-35640243

RESUMO

BACKGROUND: To assess the feasibility and acceptability of conducting a trial of the clinical effectiveness and cost-effectiveness of a new case-management intervention to facilitate the return to work of health care workers, on sick leave, having a common mental disorder (CMD). METHODS: A mixed methods feasibility study. RESULTS: Systematic review examined 40 articles and 2 guidelines. Forty-nine National Health Service Occupational Health (OH) providers completed a usual care survey. We trained six OH nurses as case managers and established six recruitment sites. Forty-two out of 1938 staff on sick leave with a CMD were screened for eligibility, and 24 participants were recruited. Out of them, 94% were female. Eleven participants received the intervention and 13 received usual care. Engagement with most intervention components was excellent. Return-to-work self-efficacy improved more in the intervention group than in the usual care group. Qualitative feedback showed the intervention was acceptable. CONCLUSIONS: The intervention was acceptable, feasible and low cost to deliver, but it was not considered feasible to recommend a large-scale effectiveness trial unless an effective method could be devised to improve the early OH referral of staff sick with CMD. Alternatively, the intervention could be trialled as a new stand-alone OH intervention initiated at the time of usual OH referral.


Assuntos
Transtornos Mentais , Retorno ao Trabalho , Feminino , Humanos , Masculino , Pessoal de Saúde , Transtornos Mentais/terapia , Saúde Mental , Licença Médica , Medicina Estatal , Estudos de Viabilidade , Ensaios Clínicos como Assunto
3.
Occup Med (Lond) ; 72(2): 125-131, 2022 02 22.
Artigo em Inglês | MEDLINE | ID: mdl-34865150

RESUMO

BACKGROUND: Stammering (stuttering) is a speech condition with high heterogeneity, affecting approximately 1% of adults. Research shows it can limit career progression, impact job performance and quality of life. AIMS: To assess the psychosocial impact of stammering among healthcare workers and to develop a new workplace support intervention. METHODS: A cross-sectional questionnaire of healthcare workers who stammer with qualitative work and a survey of occupational health (OH) usual care to assess the need for a workplace intervention. RESULTS: Data from 470 staff questionnaires and 32 OH clinicians were analysed. Eighty-four per cent rated their stammering severity as mild-to-moderate, with the majority reporting adverse impact on job performance and career progression. Most experienced a high degree of anxiety and embarrassment at work, with avoidance behaviours commonplace. Four per cent of respondents sought OH advice for work difficulties. Qualitative data highlighted practical challenges staff experience in the workplace. Sixty-five per cent supported the proposal for a new workplace intervention. We found workplace stress and anxiety were the most common reasons for OH referrals, and we found wide variation in the scope of OH assessments and work adjustments recommended. Most OH respondents reported insufficient clinical knowledge of speech disorders and their impact on work. CONCLUSIONS: Stammering can have a negative impact of workers' job performance and job satisfaction. This can precipitate feelings of stress and anxiety, and can affect self-identity at work. We found wide variation in the provision of OH usual care. The results informed the development of a new workplace intervention.


Assuntos
Gagueira , Adulto , Estudos Transversais , Humanos , Satisfação no Emprego , Qualidade de Vida , Inquéritos e Questionários , Local de Trabalho/psicologia
4.
Occup Med (Lond) ; 2022 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-36039847

RESUMO

BACKGROUND: The global coronavirus (Covid-19) pandemic created a profound disruption to the delivery of planned scientific research with unknown immediate and potentially longer-term impacts. AIMS: We explored researchers' experiences of the impact of the pandemic on the continued development and delivery of research into work and health, and on research infrastructure in this field. METHODS: A cross-sectional study. RESULTS: Thirty-three questionnaires were completed, representing a response rate of 15%. Sixty-one per cent of respondents were female, the majority (78%) had over 11 years of research experience and 76% worked mainly in academia. Most respondents (88%) were able to progress with research during the pandemic. A small proportion (4%) had studies paused or suspended due to the pandemic, while a larger proportion (19%) had research staff redeployed to assist with other studies or furloughed. Respondents described a range of emerging practical and logistical issues for research into work and health during the pandemic. Some benefited from increased opportunities to collaborate on new multidisciplinary studies, opportunities to engage participants in work and health research, and more flexible and inclusive work practices. Others experienced challenges that had an adverse impact, such as hampering research delivery (e.g. barriers to participant screening and intervention delivery), poor (home) working environments, reduced team cohesion and isolation. A range of future priorities for research was highlighted. CONCLUSIONS: We describe lessons learned and opportunities that can be used to support or further research activities in the field of work and health research in the future.

5.
Occup Med (Lond) ; 72(7): 456-461, 2022 10 18.
Artigo em Inglês | MEDLINE | ID: mdl-35815920

RESUMO

BACKGROUND: We sought to explore the value and benefits of accredited specialists employed in the National Health Service (NHS), and proposed strategies for expanding their role. AIMS: To explore the core characteristics of accredited specialists and to examine how their skills could be further utilized to enhance occupational health (OH) services. METHODS: Mixed methods comprising a survey and qualitative work. RESULTS: OH survey was completed by 65 of 128 (51%) respondents. Nine accredited specialists and 16 stakeholders contributed qualitative data. Most OH departments were located in acute NHS trusts and additionally provided externally contracted services. We found a large variation in OH staffing and OH services delivered. The COVID pandemic created unprecedented challenges and required expansion in services to meet demand. The majority of respondents described greater recognition and appreciation by others of accredited specialists and OH teams for their specialist contribution during the pandemic. From the qualitative data, we identified two overarching themes. 'Professional credibility has currency' (Theme 1) and 'A visionary future' (Theme 2). A series of sub-themes are described. CONCLUSIONS: Accredited specialists employed in the NHS possess a core set of attributes and capabilities, and are skilful at delivering strong, influential and impactful clinical and strategic leadership across the NHS hierarchy and landscape. The COVID pandemic provided valuable opportunities for them to showcase their specialist clinical and leadership skills. The current wider reorientation of NHS clinical services offers bold new ways to expand their role beyond traditional clinical boundaries.


Assuntos
COVID-19 , Serviços de Saúde do Trabalhador , Humanos , Liderança , Medicina Estatal , COVID-19/epidemiologia , Especialização
6.
Occup Med (Lond) ; 72(4): 264-272, 2022 05 23.
Artigo em Inglês | MEDLINE | ID: mdl-35363314

RESUMO

BACKGROUND: Hand dermatitis is a well-established occupational risk in nursing staff. AIMS: To explore skin health in nursing staff and to develop resources and recommendations to promote good skincare at work. METHODS: Cross-sectional survey. RESULTS: We analysed data from 1,545 surveys. Forty-six percent reported 'poor' skin health and the majority (93%) experienced at least one skin problem over the previous 12 months, with only 22% seeking help from their employer. Only 2% took time off work due to skin problems, with many expressing concerns that taking sick leave would be viewed negatively by others. Over half (53%) had reduced or stopped using antibacterial rubs and soap, and 18% had reduced the use of gloves. Most respondents used hand cream and over half used products they had purchased themselves. Only 42% received skin health care information from employers, with fewer (26%) receiving training on how to identify early signs of skin disease. Only 16% had access to skin surveillance in line with regulatory requirements. Only 26% of respondents were aware of the support offered by their professional nursing association. Suggestions for improving skin health included increasing publicity concerning the importance of skin health in healthcare settings, improving access to hand creams, better quality products, enhanced education and training and more involvement from Occupational Health (OH). CONCLUSIONS: Results confirm that poor skin health remains a persistent problem for nurses. Employers could do more to promote skin health and nurses need to be made more aware of the support and guidance offered by professional bodies.


Assuntos
Enfermeiras e Enfermeiros , Recursos Humanos de Enfermagem , Saúde Ocupacional , Estudos Transversais , Humanos , Pele , Inquéritos e Questionários
7.
Occup Med (Lond) ; 72(4): 260-263, 2022 05 23.
Artigo em Inglês | MEDLINE | ID: mdl-35233606

RESUMO

BACKGROUND: There has been increasing evidence that physicians in gynaecology are not routinely enquiring about work during consultations. AIMS: To explore the effect gynaecological conditions can have on work functioning, the importance of work outcomes among patients and whether work considerations are discussed during clinical consultations. METHODS: A cross-sectional survey was administered to employed patients attending a gynaecological clinic at Guy's Hospital. The survey assessed four areas: demographics, gynaecological condition (including self-assessed severity), work status and perceived impact of the condition on work functioning and job satisfaction. Simple descriptive analysis and statistical techniques were used to interpret the data. RESULTS: One hundred and six participants participated (mean age: 37.49 ±â€…9.09). About 95% found it important to be able to work whilst receiving treatment and 82% of patients had reported at least a slight impact on their working ability due to their condition. Of the 31 patients for whom it was their first appointment, 77% said it would be useful to discuss the possible impacts their gynaecological condition could have on their work. About 66% (19/29) of the participants attending a follow-up appointment reported that their doctor had not discussed their work with them. CONCLUSIONS: The symptoms of gynaecological conditions can impact patients' ability to work. There is a lack of useful discussion from doctors about the perceived impact gynaecological conditions can have on a patient's ability to work, despite patients finding it important to be able to remain or return to work.


Assuntos
Ginecologia , Médicos , Adulto , Estudos Transversais , Humanos , Satisfação no Emprego , Pessoa de Meia-Idade , Inquéritos e Questionários
8.
Br J Dermatol ; 183(3): 462-470, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-31989580

RESUMO

BACKGROUND: Occupational hand dermatitis poses a serious risk for nurses. OBJECTIVES: To evaluate the clinical and cost-effectiveness of a complex intervention in reducing the prevalence of hand dermatitis in nurses METHODS: This was a cluster randomized controlled trial conducted at 35 hospital trusts, health boards or universities in the UK. Participants were (i) first-year student nurses with a history of atopic conditions or (ii) intensive care unit (ICU) nurses. Participants at intervention sites received access to a behavioural change programme plus moisturizing creams. Participants at control sites received usual care. The primary outcome was the change of prevalent dermatitis at follow-up (adjusted for baseline dermatitis) in the intervention vs. the control group. Randomization was blinded to everyone bar the trials unit to ensure allocation concealment. The trial was registered on the ISRCTN registry: ISRCTN53303171. RESULTS: Fourteen sites were allocated to the intervention arm and 21 to the control arm. In total 2040 (69·5%) nurses consented to participate and were included in the intention-to-treat analysis. The baseline questionnaire was completed by 1727 (84·7%) participants. Overall, 789 (91·6%) ICU nurses and 938 (84·0%) student nurses returned completed questionnaires. Of these, 994 (57·6%) had photographs taken at baseline and follow-up (12-15 months). When adjusted for baseline prevalence of dermatitis and follow-up interval, the odds ratios (95% confidence intervals) for hand dermatitis at follow-up in the intervention group relative to the controls were 0·72 (0·33-1·55) and 0·62 (0·35-1·10) for student and ICU nurses, respectively. No harms were reported. CONCLUSIONS: There was insufficient evidence to conclude whether our intervention was effective in reducing hand dermatitis in our populations. Linked Comment: Brans. Br J Dermatol 2020; 183:411-412.


Assuntos
Dermatite Ocupacional , Eczema , Análise Custo-Benefício , Dermatite Ocupacional/epidemiologia , Dermatite Ocupacional/prevenção & controle , Mãos , Humanos , Medicina Estatal , Inquéritos e Questionários
9.
Occup Med (Lond) ; 70(6): 394-399, 2020 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-32756894

RESUMO

BACKGROUND: Few data are available on the pattern of use of fit notes issued in secondary care settings. AIMS: To evaluate the pattern and quality of e-fit notes issued in an NHS Trust. METHODS: Anonymized data on patients admitted to Guy's and St Thomas' NHS Foundation Trust (London, UK) who had an e-fit note issued from 1 January to 31 August 2017 were analysed using descriptive statistical methods. Thematic analysis was used to group the free-text comments into distinct categories and themes. RESULTS: A total of 815 fit notes were issued during the study period. A total of 659 (81%) fit notes advised that patients were 'not fit' for work, whilst 156 (19%) advised that they 'may be fit' for work. The specialty with the highest proportion of patients assessed as may be fit was plastic surgery 46/104 (44%), whilst the lowest was ear, nose and throat surgery 0/57 (0%). The majority 151/156 (97%) of fit notes which advised that patients may be fit for work used the tick-box sections on the fit note to recommend work modifications. Of the free-text comments in section 4 of the 'may be fit' e-fit notes issued, 91/114 (80%) were related to the functional ability of patients. CONCLUSIONS: Our study suggests that doctors in secondary care are more willing to use the 'may be fit' option on the fit note than primary care practitioners. Most fit notes, which advised that a patient may be fit for work, suggested workplace modifications.


Assuntos
Retorno ao Trabalho , Atenção Secundária à Saúde/estatística & dados numéricos , Avaliação da Capacidade de Trabalho , Inglaterra , Humanos , Prontuários Médicos , Saúde Ocupacional
10.
Occup Med (Lond) ; 70(9): 645-648, 2020 Dec 30.
Artigo em Inglês | MEDLINE | ID: mdl-33219375

RESUMO

BACKGROUND: Hand dermatitis is highly prevalent among nurses due to their frequent exposure to wet work. Providing cost-effective dermatological health surveillance for this occupational group presents a challenge to health service providers. AIMS: To ascertain the predictive value of nurses' self-assessment of whether they had current hand dermatitis using a screening questionnaire when compared with the assessment made by a dermatologist of the nurses' hand photographs. METHODS: We conducted a cross-sectional study comparing the self-report decision made by student and intensive care nurses using a single hand dermatitis screening question with the clinical assessment of their hand photographs made by dermatologists using a standardized photographic guide. RESULTS: We analysed data collected at study baseline (n = 1599). The results showed that the screening question had a high negative predictive value (91%; 95% CI 89-93), but a low positive predictive value (39%; 95% CI 34-45). It demonstrated acceptable accuracy in distinguishing those with and without the disease (area under the receiver operator curve = 0.7) and had a high specificity (86%; 95% CI 84-88) but a sensitivity of only 52% (95% CI 46-59) in identifying hand dermatitis. CONCLUSIONS: We found that nurses were able to accurately self-assess themselves as not having any signs of hand dermatitis. By contrast, they were less able to accurately self-assess positive cases suggesting under-recognition of early disease. We propose that a questionnaire containing a single hand dermatitis screening question should be considered as a tool for screening out clear cases as part of a workplace health surveillance programme for detecting hand dermatitis.


Assuntos
Dermatite Ocupacional , Dermatoses da Mão , Enfermeiras e Enfermeiros , Estudos Transversais , Humanos , Autorrelato , Inquéritos e Questionários
11.
Occup Med (Lond) ; 69(4): 290-293, 2019 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-31087067

RESUMO

BACKGROUND: Approximately a quarter of sickness absence in the UK National Health Service (NHS) is attributed to common mental health disorders (CMHDs). This is costly to the NHS and impacts on patient care and staff morale. Little is known about the occupational health (OH) management of NHS staff who take sick leave for CMHDs. AIMS: To explore the current OH management of NHS staff on sick leave for CMHDs. METHODS: We invited providers of NHS OH services identified from the NHS Health at Work Network and Commercial OH Providers Association to complete a survey on the management of employees off work because of CMHDs. Analysis involved descriptive statistics and content analysis. RESULTS: Forty-nine (39%) of the 126 OH departments approached responded. The majority (98%) had an organizational sickness absence policy that included triggers for referral for staff absent with CMHDs. In 63%, referral occurred 8-28 days after the onset of absence; in 92%, the consultation was completed by an OH nurse or OH physician. Content of the first consultation often included assessment of symptoms and medication for CMHDs. Case management and regular reviews were least commonly used despite evidence on their effectiveness in supporting return to work. All providers offered some support for managers of staff with CMHDs. CONCLUSION: Variation existed between providers of NHS OH services in the timing of referrals, use of case management and regular reviews for staff with CMHDs. Our findings suggest that current evidence-based guidance on interventions to improve return to work is not being implemented consistently.


Assuntos
Pessoal de Saúde/psicologia , Transtornos Mentais/terapia , Licença Médica , Administração de Caso , Humanos , Transtornos Mentais/reabilitação , Medicina do Trabalho , Política Organizacional , Retorno ao Trabalho , Medicina Estatal/organização & administração , Inquéritos e Questionários , Reino Unido
13.
Occup Med (Lond) ; 68(5): 340-342, 2018 06 20.
Artigo em Inglês | MEDLINE | ID: mdl-29741666

RESUMO

Background: Nurses are at high risk of hand dermatitis. Regular hand moisturizing can prevent dermatitis, but nurses' use of hand moisturizers is suboptimal. Aims: To establish (i) what beliefs about hand dermatitis and hand moisturizer use are associated with hand moisturizer use by nurses at home and at work and (ii) if hand moisturizer use behaviours in nurses are associated with the prevalence of hand dermatitis. Methods: We used a questionnaire to investigate nurses' knowledge, beliefs and behaviours regarding hand dermatitis and use of hand moisturizers. Results: The response rate was 55/65 (85%). Forty-two (76%) participants agreed that applying hand moisturizers reduced the risk of dermatitis, and 53 (96%) agreed that dermatitis increased the risk of skin carrying pathogenic organisms. Frequent moisturizer application was associated with beliefs that it was part of the nurse's role to apply hand creams, a belief that they had had training in the use of moisturizers and believing that patients approved of them moisturizing their hands. Conclusions: Hand moisturizer use by nurses can be improved by enhancing their beliefs that it is part of their professional role to apply hand cream regularly.


Assuntos
Dermatoses da Mão/prevenção & controle , Mãos , Enfermeiras e Enfermeiros/psicologia , Creme para a Pele/farmacologia , Adulto , Feminino , Humanos , Masculino , Higiene da Pele/métodos , Higiene da Pele/psicologia , Creme para a Pele/uso terapêutico , Inquéritos e Questionários
14.
Occup Med (Lond) ; 67(4): 305-307, 2017 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-28371932

RESUMO

BACKGROUND: Postal questionnaires remain an important method of collecting data in trials. However, a high non-response rate can lead to biases, which may undermine the validity of the study. AIMS: To assess a simple method of trying to improve response rates in an occupational health trial evaluating an intervention to prevent hand dermatitis in nurses. METHODS: The trial employed questionnaires at t = 0, t = 1 month and t = 12 months. The t = 1 month questionnaire was posted to study participants (student and intensive care nurses) together with a free postage reply envelope. After 2 weeks, an e-mail was sent to non-responders reinforcing the need for completed questionnaires to be returned. Two weeks later, non-responders were sent another hard copy of the questionnaire, along with an accompanying letter. Six weeks after posting the initial questionnaires, non-responders were sent an SMS text message or were telephoned to remind them to return the questionnaire. RESULTS: The response rates for the 744 student nurses were 8% (no reminder), 27% (after first reminder), 22% (after second reminder) and 27% (after the third reminder), resulting in a response rate of 63%. The response rates for the 959 intensive care nurses were 9% (no reminder), 24% (after first reminder), 24% (after second reminder) and 31% (after third reminder), resulting in a final response rate of 63%. CONCLUSIONS: We found that a series of regular reminders including a third, personalized reminder by SMS text or telephone had a positive impact on non-responders.


Assuntos
Correio Eletrônico , Serviços Postais/métodos , Inquéritos e Questionários/estatística & dados numéricos , Telefone , Envio de Mensagens de Texto , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros , Estudantes de Enfermagem , Reino Unido
15.
Ann Hematol ; 95(2): 227-32, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26490882

RESUMO

Venous thromboembolism (VTE) is a recognised complication of sickle cell disease (SCD), long considered to be a hypercoagulable state. While there is a good understanding of arterial thrombosis in SCD, the nature of VTE in SCD is less well-characterised. In this retrospective cohort study, we found that the incidence of VTE in our patient cohort was higher than in the non-SCD black population; patients of all SCD genotypes with VTE had significantly elevated steady-state platelet counts compared to those without. Recent hospitalisation (typically with acute sickle pain) was the commonest precipitating risk factor. These findings suggest consideration of longer VTE prophylaxis for acute hospital admissions in SCD.


Assuntos
Anemia Falciforme/diagnóstico , Anemia Falciforme/epidemiologia , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/epidemiologia , Adolescente , Adulto , Anemia Falciforme/terapia , Estudos de Coortes , Feminino , Hospitalização/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Reino Unido/epidemiologia , Tromboembolia Venosa/terapia , Adulto Jovem
16.
Eur J Cancer ; 29A(1): 15-21, 1992.
Artigo em Inglês | MEDLINE | ID: mdl-1445735

RESUMO

A total of 153 breast cancer patients who participated in two trials of adjuvant tamoxifen and who had not recurred were recruited into a study of the long term effects of tamoxifen. There were 60 controls (no tamoxifen), 73 ex-users (mostly for 2 years) and 20 current users (median treatment duration 72 months) and the median follow-up time was 7 years. A wide ranging study of lipids, hormones, bone density and haemostasis was undertaken. When compared with controls, current users had lower cholesterol levels (especially low density cholesterol), and increased triglyceride levels. Thyroid hormones were higher and sex hormone binding globulin was almost doubled. Bone density was non-significantly higher, clotting times were slightly shorter and fibrinogen and antithrombin III levels were reduced. However few of these changes persisted in ex-users, suggesting that most of the biological effects of treatment are reversible on cessation of treatment. This is reassuring for potentially negative side-effects, but also indicates that potentially positive 'side-effects' such as cholesterol lowering only occur while on active treatment.


Assuntos
Neoplasias da Mama/sangue , Tamoxifeno/farmacologia , Densidade Óssea/efeitos dos fármacos , Neoplasias da Mama/tratamento farmacológico , Colesterol/sangue , Feminino , Seguimentos , Glicerídeos/sangue , Hemostasia , Humanos , Assistência de Longa Duração , Globulina de Ligação a Hormônio Sexual/metabolismo , Tamoxifeno/uso terapêutico , Hormônios Tireóideos/sangue
17.
Transplantation ; 44(2): 223-7, 1987 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-3307046

RESUMO

Twenty needle biopsies from 14 patients were taken at times of renal dysfunction, and frozen sections were stained for class I and class II major histocompatibility complex (MHC) antigen expression using the immunoperoxidase technique and monomorphic mouse monoclonal antibodies. Eight of the 9 biopsies taken during periods of dysfunction attributed to cyclosporine toxicity had normal levels of class II expression. In contrast, 9 of the 10 biopsies taken during episodes of rejection had easily recognized increases in class II expression. In the one case where no definite clinical diagnosis was possible, no class II induction was present. Class I levels were less definitive but tended to be markedly raised in the cases of rejection, and only mildly raised in the cases of nephrotoxicity. Biopsy results can be available within 1 1/2-2 hr. The test is therefore likely to be of value in the correct diagnosis of the cause of renal dysfunction and thereby improve the management of cyclosporine-treated renal transplant patients.


Assuntos
Ciclosporinas/toxicidade , Rejeição de Enxerto , Antígenos HLA/análise , Antígenos HLA-D/análise , Transplante de Rim , Anticorpos Monoclonais , Biópsia por Agulha , Diagnóstico Diferencial , Humanos , Rim/efeitos dos fármacos , Rim/patologia , Túbulos Renais/imunologia , Leucócitos/patologia , Fatores de Tempo
18.
J Am Geriatr Soc ; 48(9): 1132-5, 2000 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-10983915

RESUMO

OBJECTIVE: To provide estimates by sex and age and by sex and race/ethnicity of the proportion of older Americans who have difficulty with functional limitations and daily activities. SETTING: The Third National Health and Nutrition Examination Survey (NHANES III) 1988-1994. DESIGN: A cross-sectional nationally representative survey. PARTICIPANTS: All persons aged 60 and older who completed a household interview (N = 6,866) during NHANES III (conducted 1988-1994). MEASUREMENTS: The self-reported physical and functional disability questions from NHANES III included: lower-extremity function, instrumental activities of daily living, basic activities of daily living, needing help with personal and routine daily activities, and use of assistive devices for walking. RESULTS: Non-Hispanic black and Mexican-American men and women generally reported significantly (P < .01) more disability than did non-Hispanic white men and women. Disability was greater for minority women than for men. For both men and women, the prevalence in disability increased significantly (P < .01) with age for each measure. CONCLUSIONS: These sex-age and sex-race/ethnicity national estimates of disability indicate that minority women may represent a vulnerable subpopulation.


Assuntos
Atividades Cotidianas , Idoso/estatística & dados numéricos , Pessoas com Deficiência/estatística & dados numéricos , Distribuição por Idade , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Avaliação Geriátrica , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação das Necessidades , Inquéritos Nutricionais , Vigilância da População , Prevalência , Grupos Raciais , Distribuição por Sexo , Inquéritos e Questionários , Estados Unidos
19.
J Am Geriatr Soc ; 48(9): 1136-41, 2000 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-10983916

RESUMO

OBJECTIVE: This report provides reliability and prevalence estimates by sex, age, and race/ethnicity of an observed physical performance examination (PPE) assessing mobility and balance. SETTING: The Third National Health and Nutrition Examination Survey (NHANES III) 1988-1994. DESIGN: A cross-sectional nationally representative survey. PARTICIPANTS: All persons aged 60 and older (n = 5,403) who performed the PPE either in the mobile examination center (MEC) or in the home during NHANES III (conducted 1988-1994). MEASUREMENTS: The PPE included timed chair stand, full tandem stand, and timed 8-foot walk. RESULTS: Timed chair stand and 8-foot timed walk were reliable measurements (Intraclass Correlations > 0.5). Women were significantly slower (P < .001) than men for both timed chair stands and timed walk. Non-Hispanic white men and women did the maneuvers in significantly less time than non-Hispanic black men and women and Mexican Americans women (P < .001). CONCLUSIONS: Lower extremity functions measured by timed chair stand and walk are reliable. Women at every age group were more physically limited than men.


Assuntos
Atividades Cotidianas , Avaliação Geriátrica , Exame Físico/métodos , Exame Físico/normas , Equilíbrio Postural , Caminhada , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Estudos Transversais , Pessoas com Deficiência/estatística & dados numéricos , Feminino , Humanos , Masculino , Inquéritos Nutricionais , Variações Dependentes do Observador , Prevalência , Grupos Raciais , Reprodutibilidade dos Testes , Distribuição por Sexo , Fatores de Tempo
20.
J Clin Pathol ; 43(6): 457-60, 1990 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-2380394

RESUMO

To explore the incidence of thin membrane nephropathy (thin basement membrane syndrome, benign familial haematuria), glomerular basement membrane thickness was assessed by light and electron microscopy and by morphometry in a series of newly transplanted allograft kidneys, in lieu of normal kidney specimens. Five of the 76 donors possessed an abnormally thin basement membrane, similar to that observed in thin membrane nephropathy, while in two others the measurements fell in the overlap range between thin and normal. Seven donors therefore had a definite or possible basement membrane lesion. After taking account of an additional series of controls, unrelated to transplantation, it is suggested that the incidence of this abnormality in the general population lies between 5.2% and 9.2%. Circumstances did not allow any association between a thin basement membrane and haematuria or other clinical manifestations to be detected.


Assuntos
Glomerulonefrite/patologia , Hematúria/patologia , Glomérulos Renais/ultraestrutura , Adolescente , Adulto , Idoso , Antropometria , Membrana Basal/ultraestrutura , Criança , Feminino , Glomerulonefrite/epidemiologia , Hematúria/congênito , Humanos , Masculino , Microscopia Eletrônica , Pessoa de Meia-Idade
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