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Biomedical subjects

B Raphael

Publications and source records attributed to B Raphael.

At least 19 recordsLinked to original sources
PubMed1992

Clinical depression is associated with impaired recovery from stroke.

OBJECTIVE: To examine the effect of clinical depression on recovery from stroke. METHOD: We examined a cohort of inpatients with stroke initially at two months after their stroke and again 14 months later. Patients were included if they: (i) provided informed consent; (ii) were able to understand the interview questions; and (iii) survived to follow-up without suffering another stroke or major medical illness. Of 61 consecutive patients, 49 met these criteria. Depression was diagnosed using a structured clinical interview. Three aspects of recovery were measured: (i) functional status; (ii) activities of daily living; and (iii) cognitive performance. RESULTS: Twenty (41%) of the 49 patients were depressed at initial assessment. There were no significant differences in demographic, clinical, stroke or lesion characteristics between the depressed and non-depressed patients. At follow-up, depressed patients improved less than non-depressed patients in functional status (mean change from baseline, 23% versus 48%) (P = 0.001) and cognitive performance (-1% versus 11%) (P = 0.096). Mean recovery in activities of daily living was not different between the two groups (33% versus 32%) but more of the depressed patients deteriorated over time (20% versus 0%) (P = 0.047). CONCLUSION: Clinical depression occurring soon after stroke is associated with impaired recovery when patients are assessed 14 months later. Depression has a negative effect on recovery in functional status and cognitive performance and may produce deterioration in physical capacity in a number of patients. Physicians would be well advised to be alert for depression and intervene early. Effective treatment of depression may enhance stroke rehabilitation.

Activities of Daily Living↗
PubMed1992

Pathways to hysterectomy: insights from longitudinal twin research.

OBJECTIVE: We hypothesized that genetic influences act on "liability" to hysterectomy, that secular influences might differentially affect relative importance of genetic and environmental influences, and that the sources of genetic influences could be identified from reported risk factors. STUDY DESIGN: Hysterectomy data from an Australia-wide volunteer sample of female adult monozygotic and dizygotic twins are reported. In 1980 through 1982 a mailed questionnaire was completed by 1232 monozygotic female twin pairs and 751 dizygotic female twin pairs (3966 women) from the Australian Twin Register (wave 1). The same twins were surveyed by questionnaire 8 years later (wave 2). RESULTS: A total of 366 had undergone hysterectomy by wave 1 and a further 198 at wave 2. The twin-pair correlations for liability to hysterectomy at wave 1 (0.61 +/- 0.06 for monozygotic and 0.20 +/- 0.11 for dizygotic) and wave 2 (0.65 +/- 0.05 for monozygotic and 0.32 +/- 0.09 for monozygotic) indicated a substantial genetic contribution. Reported risk factors accounted for only 15% of total variance. CONCLUSION: Genetic influences on liability to hysterectomy were substantial and stable across birth cohorts, but the important sources of genetic influence on liability to hysterectomy are yet to be identified.

Adolescent↗
PubMed1992

A high-risk community study of paternal alcohol consumption and adolescents' psychosocial characteristics.

A prospective community study looked at drinking behavior and biopsychosocial correlates of adolescents (in years 9 and 10 and again in years 11 and 12 at 23 high schools) and their parents. Heavy drinkers were compared to nil/low drinkers. Sons were more likely to drink heavily if fathers drank heavily and mothers who drank heavily were more likely to cohabit with heavy drinkers. Differences in psychological characteristics and home environment were defined in regard to heavy drinking fathers and drinking sons. Difficulty in settling disagreements and reduced time spent with family were the main correlates associated with drinking by both boys who did not necessarily have a heavy drinking father and those who did.

Adolescent↗
PubMed1992

Adult attachments and sexuality: implications for understanding risk behaviours for HIV infection.

In response to the AIDS epidemic, there has been an intensification of interest in human sexuality research in general and "safe sex" practices in particular. Most research models have been somewhat mechanistic in focus, however, with little recognition of the significance of affectional needs in the formation and maintenance of sexual relationships. In this paper we propose that relationship issues are central to an understanding of the expression of sexuality, and that attachment theory provides a useful perspective on human sexual bonds. It is suggested that future research could usefully extend the conceptualisation of adult attachment styles by exploring the meaning of attachment relationships for gay and heterosexual couples, and the implications of attachment style for the behaviours associated with sexual relationships, including the negotiation of safe sex practices. Such research would have direct relevance for prevention programs relevant to HIV/AIDS.

HIV Infections↗
PubMed1992

[Mountain sports: their role in 2200 facial injuries occurring over 4 years at the University Hospital Center in Grenoble].

Injuries caused by mountain sports account for many of the injuries admitted to the University Hospital of Grenoble. Out of 4,490 traumas, 470 were injuries sustained during the practice of mountain sports. While the frequency of these accidents does not evolve much, the etiological distribution depends on fashion. Thus an increasing number of lesions caused by cross-country biking has been noted during the past two years. We find it urgent to propose protective measures adapted to this new sport.

Accidents↗
PubMed1992

Growth of human corneal endothelium on altered Descemet's membrane.

To determine whether Descemet's membrane (DM), which is altered by disease, interferes with endothelial cell growth, healthy human corneal endothelial cells were seeded onto DM from normal corneas and diseased corneal buttons from patients with Fuchs' endothelial dystrophy and pseudophakic bullous keratopathy (PBK). DM was first peeled off the corneal specimens and the endothelial cells removed by trypsinization. A suspension of first-passage corneal endothelial cells (2,000 cells/microliters; obtained from donor eye bank eyes and grown in Dulbecco's minimal essential medium with 10% fetal bovine serum and 1.5% chondroitin sulfate) were seeded on DM. Epidermal growth factor (10 ng/ml) and insulin (1 U/ml) were added to the medium after seeding cells on the DM. The cells attached and flattened within 1 hour and reached confluency in 1 week on normal DM. Cells grown on DM from corneas of patients with Fuchs' endothelial dystrophy also flattened and grew to confluency in 1 week. Cells grown on DM from corneas of patients with PBK did not grow to confluency. Further studies with bovine and rabbit corneal endothelial cells showed similar growth pattern to human cells. These data indicate that DM from corneas of patients with Fuchs' dystrophy does not interfere with the growth of corneal endothelial cells but that DM from corneas of patients with PBK does interfere with cell growth.

Animals↗
PubMed1992

[The pathologically changed Descemet membrane. Cultivation of human corneal endothelium on transformed membrane].

Corneal endothelial diseases are connected with structural and biochemical changes of Descemet's membrane (DM). Little is known about the possible effects of these changed basement membranes. In the present study we investigated the influence of changed DM on endothelium. Human corneal endothelial cells were cultured on DM of healthy corneas as well as corneas with Fuchs' endothelial dystrophy or bullous keratopathy, and cell growth and morphology were compared. On healthy DM, cells formed a confluent monolayer within 4 days. Cells cultured on Fuchs' DM showed a similar pattern. The polygonal cell pattern was interrupted merely in the area of the guttae, which were covered by cell processes alone. Culturing cells proved to be difficult on DM from corneas with bullous keratopathy. Even though the cells attached to the DM, they did not spread but became spindle shaped and rarely formed intercellular contacts. Even after 7 days no confluent monolayer was established. These results indicate that some though not all pathological DM changes interfere with cell growth.

Adult↗
PubMed1992

The relationship between risk factors for affective disorder and poststroke depression in hospitalised stroke patients.

The influence of psychiatric risk factors on the development of depression following stroke was examined in 88 patients undergoing inpatient rehabilitation. In this sample, 34 patients (38%) had a diagnosis of major or minor depression. Older age and a personal or family history of affective or anxiety disorder were associated significantly with major depression. Minor depression was more common among males and those patients with greater physical disability. Severity of depressive symptoms was associated with a personal or family history of affective or anxiety disorder and higher pre-stroke personality neuroticism. We conclude that certain psychiatric risk factors for affective disorder are strongly associated with poststroke depression. The implications of these findings for anticipating and managing poststroke depression are discussed.

Adaptation, Psychological↗
PubMed1991

Antenatal prediction of mother-infant difficulties.

A prospective study of 143 "low risk" pregnant women expecting their first baby was conducted in Newcastle, Australia. The study was designed to examine the contribution of a woman's perception of her own childhood experiences, her trait anxiety level, socioeconomic status, and social support network to difficulties in her relationship with her baby during the baby's first year. The women were initially interviewed during pregnancy and followed up 3 and 12 months postpartum. Follow-up measures included the Dimensions of Perinatal Adjustment, the Neonatal Perception Inventory, the Ainsworth Strange Situation, and information from hospital records, family doctors, and baby health centre sisters. Women who perceived their social network as less supportive during pregnancy were likely to see their one-year-old babies (p less than .05) as more difficult. The other antenatal measures were not significantly predictive of outcome.

Adolescent↗
PubMed1991

The relationship between the perception of social support and post-stroke depression in hospitalized patients.

In our study we examined the relationship between the perceived adequacy of social support and post-stroke depression in 76 hospitalized Australian patients. Social support or the perception of its lack, particularly from a spouse care-giver, was associated significantly with both the presence and severity of depressive disorder. Furthermore, depressed patients who perceived their support to be inadequate had a longer duration of depressive illness than depressed patients who perceived their support in a more favorable light. We conclude that following stroke, perception of social support from key relationships may mediate the emotional response to this life crisis. The implications of these findings are discussed.

Adaptation, Psychological↗
PubMed1991

A community screening test for high alcohol consumption using biochemical and haematological measures.

A discriminant function based on a number of biochemical and haematological tests from an extended multiple biochemical analysis and full blood count, together with weight, smoking status and systolic blood pressure is developed. The function was far more effective at detecting high alcohol use (greater than 40 g ethanol per day) than serum gamma-glutamyl transpeptidase (GGT) or the Short Michigan Alcoholism Screening Test (SMAST) in a community sample of adult males. When classifying high alcohol consumption by GGT only, several division criteria were considered, the most effective being at 40 i.u./l. In terms of identifying high alcohol consumers, rather than alcoholics, the SMAST was no better than GGT, and both had unacceptably low sensitivity (49%, 51%) and poor performance on other measures, thus limiting their use as community screening tools. The discriminant function, however, had an estimated community sensitivity of 78%, was similarly high on other performance measures, and would perform satisfactorily as a community screening tool, particularly in situations where there was a tendency for individuals to under-report their alcohol consumption.

Adult↗
PubMed1991

Relationships between mental adjustment to HIV diagnosis, psychological morbidity and sexual behaviour.

This paper examines patterns of psychological adjustment in a small sample of asymptomatic HIV antibody positive men. Comparison is made with data available on male cancer patients. HIV positive men reported greater degrees of anxious preoccupation and hopelessness, and lower levels of the more adaptive 'fighting spirit' response. In HIV-infected men, depression correlated positively with frequency of high risk sexual practices.

Adaptation, Psychological↗
PubMed1991

Comparison of chlorambucil and prednisone versus cyclophosphamide, vincristine, and prednisone as initial treatment for chronic lymphocytic leukemia: long-term follow-up of an Eastern Cooperative Oncology Group randomized clinical trial.

The Eastern Cooperative Oncology Group (ECOG) conducted a study in which patients with advanced chronic lymphocytic leukemia (CLL) were randomized between a regimen consisting of chlorambucil (30 mg/m2 orally day 1) and prednisone (80 mg orally days 1 to 5) (C + P) administered every 2 weeks and a more intensive regimen of cyclosphosphamide (300 mg/m2 orally days 1 to 5), vincristine (1.4 mg/m2 intravenously [IV] day 1), and prednisone (100 mg/m2 orally days 1 to 5) (CVP) given every 3 weeks. Treatment was continued for up to 18 months to maximal response. Of the 122 eligible patients, 60 received C + P, while 62 received CVP. With a median follow-up of 7 years, there were no significant differences in survival (4.8 v 3.9 years, P = .12), complete remission (CR) rate (25% v 23%; P = .83), or duration of response (2.0 v 1.9 years; P = .78) between C + P and CVP. Toxicity was modest despite the prolonged treatment. The long median survival of 4.1 years for stage III and IV patients is superior to that usually reported. This could stem from continuing treatment to maximal response rather than an increase in intensity of therapy. These results are comparable to those reported with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) therapy by other investigators. The data suggest that intermittent C + P administered to maximal response continues to be the standard treatment approach for advanced CLL.

Adult↗
PubMed1991

The evaluation of teaching in undergraduate psychiatric education: students' attitudes to psychiatry and the evaluation of clinical competency.

There is an increasing demand for improved skills by medical graduates in the psychosocial aspects of medical care. Psychiatrists as educators need to play an important role in the development and evaluation of education in many areas of the undergraduate curriculum in addition to the continuing education of graduates. In this review approaches to the evaluation of undergraduate psychiatric education are discussed with particular emphasis on students' attitudes to psychiatry. Key issues that remain to be addressed include the clarification of the most appropriate goals for undergraduate education in psychiatry, the most valid means of evaluating such educational programmes, particularly clinical competency and, finally, the many tasks in improving the status of the psychosocial aspects of medical care for students and their clinical teachers.

Attitude of Health Personnel↗