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Biomedical subjects

A Buchanan

Publications and source records attributed to A Buchanan.

At least 19 recordsLinked to original sources
PubMed2003

Phobic anxiety in 11 nations. Part I: Dimensional constancy of the five-factor model.

The Fear Survey Schedule-III (FSS-III) was administered to a total of 5491 students in Australia, East Germany, Great Britain, Greece, Guatemala, Hungary, Italy, Japan, Spain, Sweden, and Venezuela, and submitted to the multiple group method of confirmatory analysis (MGM) in order to determine the cross-national dimensional constancy of the five-factor model of self-assessed fears originally established in Dutch, British, and Canadian samples. The model comprises fears of bodily injury-illness-death, agoraphobic fears, social fears, fears of sexual and aggressive scenes, and harmless animals fears. Close correspondence between the factors was demonstrated across national samples. In each country, the corresponding scales were internally consistent, were intercorrelated at magnitudes comparable to those yielded in the original samples, and yielded (in 93% of the total number of 55 comparisons) sex differences in line with the usual finding (higher scores for females). In each country, the relatively largest sex differences were obtained on harmless animals fears. The organization of self-assessed fears is sufficiently similar across nations to warrant the use of the same weight matrix (scoring key) for the FSS-III in the different countries and to make cross-national comparisons feasible. This opens the way to further studies that attempt to predict (on an a priori basis) cross-national variations in fear levels with dimensions of national cultures.

Adolescent↗
PubMed2003

Does 'like predict like' when patients discharged from high secure hospitals re-offend? An instrument to describe serious offences.

BACKGROUND: The statement that past behaviour is the best predictor of future behaviour has empirical support in respect of whether an individual will, or will not, commit a criminal offence. People who have offended in the past are more likely to offend in the future. The aims of this study were to develop an instrument and to examine whether the same statement applies in respect of the nature and circumstances of successive offences committed by the same person. METHOD: A rating instrument to describe seven variables relating to the nature and circumstances of a serious offence, the SODI, was developed by the authors. Inter-rater reliability was measured when the instrument was applied to 80 offences committed by 40 patients leaving high secure hospitals. The data were examined for evidence of similarity in the nature and circumstances of successive offences. RESULTS: For five of the seven items of the instrument the kappa coefficients for inter-rater reliability were > 0.65. No significant associations, in terms of SODI ratings, were found between the offence that led to hospital admission and that which was committed after discharge. CONCLUSIONS: The SODI is a reliable instrument for the description of serious offences committed by this group. Risk assessments in psychiatry should be informed by an awareness that in only a proportion of cases will the nature and circumstances of any serious re-offence resemble the nature and circumstances of the offence which contributed to a patient's admission to hospital.

Crime↗
PubMed2001

Detention of people with dangerous severe personality disorders: a systematic review.

BACKGROUND: UK government proposals to reduce the risks posed by people with "dangerous" severe personality disorders (DSPD) include a new legal framework for indeterminate detention. We aimed to establish the degree to which those operating the framework will be able to predict which people will act violently in the future. METHODS: We reviewed published reports in which the accuracy of a clinical judgment or a statistically derived rating of dangerousness was validated by its use to predict the violent behaviour of adults in the community. We calculated the sensitivity and specificity of the procedures used by every study. We then applied these sensitivities and specificities to the purported base rates of violence in people with DSPD. FINDINGS: 23 studies fulfilled the criteria, and for 21 of these the sensitivity and specificity of the procedures used by the investigators could be calculated. Using the average positive predictive power of these procedures, six people would have to be detained to prevent one violent act. Making predictions over shorter periods did not improve their accuracy. INTERPRETATION: In practice, the number of people that need to be detained is likely to be higher than we reported. Differences between populations in respect of which predictions are being made and the population on which an instrument was validated will reduce the accuracy of that instrument. Not all of the necessary information will always be available.

Commitment of Persons with Psychiatric Disorders↗
PubMed2001

Toxicity assessment of intratumoral injection of the herpes simplex type I thymidine kinase gene delivered by retrovirus in patients with refractory cancer.

Introduction of the herpes simplex type I thymidine kinase (HSV-TK) gene into tumor tissue, followed by ganciclovir, initiates a phosphorylation cascade that induces formation of a toxic ganciclovir triphosphate. Animal trials suggest that this ganciclovir triphosphate has antitumor activity. Here we report application of the HSV-TK transfection approach using a retroviral construct. Sixteen patients (median age 61.5 years) with refractory carcinoma (13 melanoma, 1 breast cancer, 1 nonsmall-cell lung cancer, and 1 osteogenic sarcoma) received intratumoral injection of HSV-TK retroviral vector at escalating doses (0.2x10(7) cfu per injection x 5 daily doses) and we evaluated them for toxicity and activity. We observed grade III pain associated with cellulitis in one patient following injection. Analysis of blood samples drawn between 3 and 28 weeks from 14 patients for replication-competent retrovirus by PCR analysis of the amphotrophic envelope revealed no replication-competent retrovirus. We injected 21 lesions. We identified no tumor responses of the injected lesions. Of 13 patients with advanced melanoma, 6 survived over one year. Thus, injection of retroviral delivered HSV-TK in patients with refractory cancer was well-tolerated.

Adult↗
PubMed2001

Intravenous infusion of a replication-selective adenovirus (ONYX-015) in cancer patients: safety, feasibility and biological activity.

Although genetically engineered adenoviruses hold promise for the treatment of cancer, clinical trial reports have utilized intratumoral injection to date. To determine the feasibility of intravenous delivery of ONYX-015, an E1B-55kD gene-deleted replication selective adenovirus with demonstrated clinical safety and antitumoral activity following intratumoral injection, we performed a clinical trial in patients with metastatic solid tumors. ONYX-015 was infused intravenously at escalating doses of 2 x 10(10) to 2 x 10(13) particles via weekly infusion within 21-day cycles in 10 patients with advanced carcinoma metastatic to the lung. No dose-limiting toxicity was identified. Mild to moderate fever, rigors and a dose-dependent transient transaminitis were the most common adverse events. Neutralizing antibody titers significantly increased within 3 weeks in all patients. IL-6, gamma-IFN, TNF-alpha and IL-10 increased within 24 h following treatment. Evidence of viral replication was detectable in three of four patients receiving ONYX-015 at doses > or = 2 x 10(12) particles and intratumoral replication was confirmed in one patient. In conclusion, intravenous infusion of ONYX-015 was well tolerated at doses up to 2 x 10(13) particles and infection of metastatic pulmonary sites with subsequent intratumoral viral replication was seen. The intravenous administration of genetically altered adenovirus is a feasible approach.

Adenocarcinoma↗
PubMed2000

Expression of Dlx genes during the development of the murine dentition.

The mammalian Dlx homeobox gene family has been shown to play multiple roles in tooth development, but a detailed comparison of the expression pattern of all members throughout tooth development has been lacking. We provide such an analysis for the six known murine Dlx genes. The expression patterns for these genes allow a refinement of previously proposed models for the role of Dlx genes in tooth type specification and raise the possibility of roles for subsets of these genes in tooth initiation, morphogenesis (enamel navel formation, enamel knot induction, cervical loop growth), and enamel formation. The relationship of Dlx gene expression to their genomic organization suggests coordinate regulation of linked genes at early stages but regulatory differences at later stages.

Animals↗
PubMed2000

Parental background, social disadvantage, public "care," and psychological problems in adolescence and adulthood.

OBJECTIVE: To assess whether the structure of the parental background (birth, restructured, widowed, single) or the context (severe social disadvantage or care) in childhood is associated with psychological problems in adolescence and adulthood. METHOD: Data on 8,441 cohort members of the National Child Development Study were used to explore the impact of parental background on maladjustment at age 16, as assessed by the Rutter A Health and Behaviour Checklist, and psychological distress at age 33, as assessed by the Malaise Inventory. RESULTS: Restructured parenting (without disadvantage or care) was not a risk factor for maladjustment at age 16. Rather, a childhood experience of care or social disadvantage was significantly related to psychosocial problems at age 16. Psychological distress at age 33 was associated with maladjustment at age 16. A childhood experience of care was associated with a tendency to adult psychological distress in men, as was growing up with a single parent. CONCLUSIONS: It is not the structure of the family background but the context that is more strongly associated with maladjustment in adolescence. A childhood experience of single parenthood and an experience of care predicted adult psychological distress in men but not in women.

Adolescent↗
PubMed2000

Changing patterns in the use of the Mental Health Act 1983 in England, 1984-1996.

BACKGROUND: The Mental Health Act 1983 (MHA) is due to be revised by Parliament in the near future. AIMS: To explore changes in the use of the Act since its introduction. METHOD: The Department of Health and the Home Office routinely collect data on the numbers of patients admitted to psychiatric hospitals under the MHA. We present absolute figures, by year, for the total numbers admitted under each section of the Act. We used the total psychiatric hospital admissions and total prison populations as denominator data. RESULTS: Formal admissions rose from 16,044 in 1984 to 26,308 in 1996, a 63% increase. Admissions under the MHA have increased as a proportion of all admissions. The increase is mainly accounted for by changes in the use of Part II of the Act, in particular sections 2 and 3. The use of forensic sections (Part III) has also increased, with a marked increase of sections 47 and 48. Use of Part X of the Act (sections 135 and 136) declined in the late 1980s but rose again in the 1990s. CONCLUSIONS: Formal admissions are more common than they were in 1984, despite there being fewer psychiatric beds. This is probably due to changes in the provision of psychiatric services, and changing societal pressures on psychiatrists away from libertarianism and towards coercion.

Commitment of Persons with Psychiatric Disorders↗
PubMed1999

Risk and dangerousness.

The task of improving the ability of clinicians to predict which of their patients will be violent has come to be seen as one of establishing the relative merits of actuarial and clinical prediction. The meaning of these terms is unclear. 'Clinical' is usually defined by exclusion, that is, as something other than actuarial. The term 'actuarial' is often used to refer to the techniques of risk prediction in financial services. In the psychiatric and psychological literature relating to the assessment of dangerousness, three further meanings have emerged. That whereby actuarial refers to any mathematical means of combining information is the most widely accepted. Whichever definition is employed, the conclusion of most reviews has been that the future is actuarial. It is argued here that, while mathematical approaches have been successful in showing that risk factors for violence in the general population apply also to the mentally disordered, important questions remain unanswered. Mathematical methods address only one form of probability, that which arises from chance. A development of another form of probability, that which arises from causes, offers the prospect of improved risk assessment in psychiatry. It also offers a definition of clinical prediction that is not based on exclusion.

Dangerous Behavior↗
PubMed1998

Hereditary hemochromatosis: gene discovery and its implications for population-based screening.

OBJECTIVE: To evaluate the role of genetic testing in screening for hereditary hemochromatosis to help guide clinicians, policymakers, and researchers. PARTICIPANTS: An expert panel was convened on March 3, 1997, by the Centers for Disease Control and Prevention (CDC) and the National Human Genome Research Institute (NHGRI), with expertise in epidemiology, genetics, hepatology, iron overload disorders, molecular biology, public health, and the ethical, legal, and social implications surrounding the discovery and use of genetic information. EVIDENCE: The group reviewed evidence regarding the clinical presentation, natural history, and genetics of hemochromatosis, including current data on the candidate gene for hemochromatosis (HFE) and on the ethical and health policy implications of genetic testing for this disorder. CONSENSUS PROCESS: Consensus was achieved by group discussion confirmed by a voice vote. A draft of the consensus statement was prepared by a writing committee and subsequently reviewed and revised by all members of the expert group over a 1-year period. CONCLUSIONS: Genetic testing is not recommended at this time in population-based screening for hereditary hemochromatosis, due to uncertainties about prevalence and penetrance of HFE mutations and the optimal care of asymptomatic people carrying HFE mutations. In addition, use of a genetic screening test raises concerns regarding possible stigmatization and discrimination. Tests for HFE mutations may play a role in confirming the diagnosis of hereditary hemochromatosis in persons with elevated serum iron measures, but even this use is limited by uncertainty about genotype-phenotype correlations. To address these questions, the expert group accorded high priority to population-based research to define the prevalence of HFE mutations, age and sex-related penetrance of different HFE genotypes, interactions between HFE genotypes and environmental modifiers, and psychosocial outcomes of genetic screening for hemochromatosis.

Female↗
PubMed1998

Haplotype structure and population genetic inferences from nucleotide-sequence variation in human lipoprotein lipase.

Allelic variation in 9.7 kb of genomic DNA sequence from the human lipoprotein lipase gene (LPL) was scored in 71 healthy individuals (142 chromosomes) from three populations: African Americans (24) from Jackson, MS; Finns (24) from North Karelia, Finland; and non-Hispanic Whites (23) from Rochester, MN. The sequences had a total of 88 variable sites, with a nucleotide diversity (site-specific heterozygosity) of .002+/-.001 across this 9.7-kb region. The frequency spectrum of nucleotide variation exhibited a slight excess of heterozygosity, but, in general, the data fit expectations of the infinite-sites model of mutation and genetic drift. Allele-specific PCR helped resolve linkage phases, and a total of 88 distinct haplotypes were identified. For 1,410 (64%) of the 2,211 site pairs, all four possible gametes were present in these haplotypes, reflecting a rich history of past recombination. Despite the strong evidence for recombination, extensive linkage disequilibrium was observed. The number of haplotypes generally is much greater than the number expected under the infinite-sites model, but there was sufficient multisite linkage disequilibrium to reveal two major clades, which appear to be very old. Variation in this region of LPL may depart from the variation expected under a simple, neutral model, owing to complex historical patterns of population founding, drift, selection, and recombination. These data suggest that the design and interpretation of disease-association studies may not be as straightforward as often is assumed.

Animals↗
PubMed1998

Perspectives on genetic aspects of dental patterning.

Nearly a century of speculation and experimentation has gone into trying to understand the mechanisms that establish the pattern of the differentiated heterodont dentition. Regionally differing qualitative (combinatorial) expression of regulatory genes appears to be involved in this process. Work by our laboratory and others shows that the six members of the mammalian Dlx family of homeobox genes are expressed (a) at multiple times during dental development, (b) differently at different stages, (c) in a way that is related to their genomic organization as gene-pairs linked to three of the four Hox clusters of positional patterning genes. The expression appears to be involved in jaw regionalization, tooth initiation, and tooth development. However, this expression correlates with no single aspect of dental patterning or tooth development, involves redundant and complementary function, and developmental differences between the maxillary and mandibular dentition suggest that other elements remain to be identified. For example, the possibility that quantitative aspects of gene expression specify developmental fields in the dentition has not yet been investigated. Although the maxilla and mandible develop differently, indirect evidence suggests that, especially in the future midline (incisor) regions, both jaws may be patterned by a consistent process that occurs before neural crest migration takes place, and we hypothesize that signaling factors like Sonic hedgehog and Pax transcription factors may be involved.

Animals↗
PubMed1998

Criminal conviction after discharge from special (high security) hospital. Incidence in the first 10 years.

BACKGROUND: The aim was to measure the criminal convictions received by people who leave special hospital and to test previously identified correlates of conviction. METHOD: A cohort study design was used and the subjects were all 425 patients discharged from the special hospitals in 1982 and 1983. The outcome measure was a criminal conviction received within 10.5 years of discharge. RESULTS: Five and a half years after discharge 26% of ex-patients had been convicted of any offence, 9% of a violent offence, 5% of a sex offence and 10% of any serious offence. Ten and a half years after discharge 34% of patients had been convicted of any offence, 15% of a violent offence, 7.5% of a sex offence and 15% of any serious offence. When other variables are controlled for, gender and destination on discharge do not predict conviction. Age, a legal category of psychopathic disorder and prior criminal record do predict, but the effect is small. CONCLUSION: The rate of conviction of patients leaving special hospital has fallen over the past 20 years; this is the case for crime in general and for serious crimes in particular. The change in rates of conviction over time for patients of different legal categories, previously thought to be different, is the same. The low predictive power of the variables examined here suggests that actuarial methods are of limited value in predicting offending in this group.

Adult↗
PubMed1998

Managed care: rationing without justice, but not unjustly.

Three ethical criticisms of managed care are often voiced: (1) by "skimming the cream" of the patient population, managed care organizations fail to discharge their obligations to improve access, or at least, to not worsen it; (2) managed care organizations engage in rationing, thereby depriving patients of care to which they are entitled; and (3) by pressuring physicians to ration care, managed care organizations interfere with physicians' fulfillment of their fiduciary obligations to provide the best care for each patient. This article argues that each of these criticisms is misconceived. The first rests on the false assumption that the health care system includes a workable division of responsibility regarding access that assigns obligations concerning access to managed care organizations. The second and third criticisms wrongly assume that we in the United States have taken the first step toward assuring equitable access to care for all, articulating a standard for what counts as an "adequate level of care" to which all are entitled. These three misguided criticisms obscure the most fundamental ethical flaw of managed care: the fact that it operates in an institutional setting within which no connection can be made between the activity of rationing and the basic requirements of justice.

Contracts↗
PubMed1997

Malaise scores in adulthood of children and young people who have been in care.

Data from the National Child Development Study are used to assess the risk of high Malaise scores (indicating a tendency towards depression) amongst young adults at age 23 and 33. Results indicate that adults who have been in care are more likely to have high Malaise scores than are those who have not been in care. For men this risk increases as they grow older. Those with an early experience of social disadvantage are also more vulnerable to a high Malaise score than those not so disadvantaged. Overall, when other factors are controlled, the risk of a high Malaise score in adulthood is significantly greater for young adults who have been in care than those who have experienced severe social disadvantage in their childhood, except for women at age 33, where an early experience of social disadvantage carries a greater risk than the care experience.

Adolescent↗
PubMed1997

Congestive heart failure in elderly patients. The treatment goal is improved quality, not quantity, of life.

Primary care physicians who see elderly patients are likely to see cases of congestive heart failure, since this condition is typically the result of long-standing hypertension or coronary artery disease. Recognizing the condition in elderly patients may not be easy, though, because clinical signs can be distorted by accompanying symptoms. In this article, the authors discuss pathophysiologic, diagnostic, and pharmacokinetic issues. They also describe therapy with diuretics, angiotensin-converting enzyme inhibitors, and digoxin and outline special considerations in the elderly.

Aged↗