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Biomedical subjects

D Goldberg

Publications and source records attributed to D Goldberg.

At least 181 records · Page 10Linked to original sources
PubMed1993

HIV risk behaviours among female prostitute drug injectors in Glasgow.

This paper focuses upon HIV-related risk behaviours of 51 female drug injecting prostitutes, interviewed as part of a serial cross-sectional study of injecting drug users in Glasgow. Forty-five per cent injected with used needles and syringes in the 6 months prior to interview. Condom use in private sexual relations was low with only 9% of those with primary partners and 22% of those with casual partners reporting consistent use of condoms with these partners. In contrast, use of condoms for all commercial sexual encounters was almost universal. Prevalence of HIV was 2.2%. Despite this low prevalence, we conclude that the level of injecting-related and private sexual risk behaviours reported here requires the continuing monitoring of drug injecting prostitutes in Glasgow.

Adolescent↗
PubMed1993

Pathways to psychiatric care in Cantabria.

This article delineates the pathways taken in different health areas of Cantabria (Spain) by a series of newly referred patients to the mental health services and explores the influence of sociodemographic, medical and service-related factors on the delays in referral. The work forms part of an ongoing World Health Organization multicentre research programme aimed at exploring and optimizing the quality of mental health care in different centres of the world. We found that, in a rural health area, the majority of newly referred patients establish the first contact with the general practitioner and to a lesser extent with the hospital doctor and from there directly progress to the psychiatric services; in the urban health area there is a greater tendency to contact specialized medical and psychiatric services. Delays in these health areas are remarkably short and are comparable to the ones in other European centres. Our data also show that somatic symptoms are the main presenting problem both at the primary care and at the mental health level; and that, in general, psychotropic drug prescriptions are high both in hospital and in general medical settings, and that women were more often prescribed psychotropic medication than men.

Female↗
PubMed1993

Mortality among injecting drug users: a critical reappraisal.

STUDY OBJECTIVE: The aim was to quantify all cause mortality among injecting drug users. DESIGN: This was a retrospective analysis of 1989 data on injecting drug users and mortality obtained from three independent agencies: the Procurator Fiscal's Office, the General Register Office, and the Scottish HIV-test register. SETTING: Greater Glasgow, Scotland. SUBJECTS: Drug injectors, estimated population 9424. MAIN RESULTS: 81 names were found using the three sources to identify deaths. After removing duplicates, 51 deaths were found. This represented a mortality rate of 0.54% in the estimated population. Among female injectors the mortality rate was 0.85%, significantly higher than the rate of 0.42% among male injectors (95% CI for the true difference in mortality rates between female and male injectors was 0.31%-0.55%). Over 90% of deaths were attributed to overdose or suicide. Although AIDS caused only one death, 19% of cases (5/27) whose HIV antibody status could be ascertained were positive. The mortality rate among HIV positive injectors (3.8%) was significantly higher than among HIV negative injectors (0.49%). CONCLUSIONS: Comprehensive coverage using three data sources revealed a far greater annual number of all cause deaths among injectors than would have been expected from previous research. The observed mortality rate was lower than in previous studies where the denominators used to calculate rates had an element of underenumeration. For the foreseeable future it is unlikely that AIDS will have much impact on mortality among injectors in Glasgow, because of the low prevalence of HIV infection among injectors in the city, and because HIV positive injectors are dying for reasons other than AIDS; rather, overdose and suicide will continue to be the main causes of death.

Adolescent↗
PubMed1993

A new community mental health team based in primary care. A description of the service and its effect on service use in the first year.

A new community multidisciplinary team based in primary care is described and the experience of the first year discussed. The effect the team has had on the use of psychiatric services in its first year was studied. There was a threefold increase in the rate of inception to care, leading to a doubling in the prevalence of treated psychiatric disorder. There has been a reduction in the demands made on the hospital out-patient services, but no change in the use of in-patient resources or emergency contacts.

Adult↗
PubMed1993

Psychiatric morbidity in older people with moderate and severe learning disability. I: Development and reliability of the patient interview (PAS-ADD).

This paper describes the development of the PAS-ADD, a semistructured clinical interview for use specifically with patients with learning disabilities, based on items drawn from the PSE. The PAS-ADD includes a number of novel features including: parallel interviewing of patient and informant; a three-tier structure to provide a flexible interview appropriate to the patient's intellectual level; use of a memorable 'anchor event' in the patient's life to improve time focus; and simplified wording, improved organisation and lay out. Inter-rater reliability was investigated using an experimental design in which two raters viewed and re-rated videotaped PAS-ADD interviews which had been conducted by an experienced clinician. Reliability results compared favourably with those obtained in a major study of PSE reliability with a sample drawn from non-learning disabled individuals. Mean kappa for all items was 0.72. Other indexes of reliability were also good. In the current phase of development, the PAS-ADD is to be expanded to include further diagnostic categories, including schizophrenia and autism. The new version will be updated for use with ICD-10 criteria.

Aged↗
PubMed1993

Psychiatric morbidity in older people with moderate and severe learning disability. II: The prevalence study.

We present a prevalence study of psychiatric morbidity in people over 50 years of age with learning disability (LD), using a new semistructured clinical interview specifically for use with people who have LD (the 'PAS-ADD'). Assessment involved parallel interviewing of subject and informant, these two sets of information being combined to reach a final diagnosis using ICD-9 and DSM-III-R criteria. Detection of dementia involved interviews with informants, plus investigation of loss of cognitive function over a three-year period. The experimental sample was a mixed community and institutional group (n = 105), including, as far as possible, all people in a single administrative district (Oldham) matching the age and ability criteria. Prevalence of psychiatric disorder excluding dementia was 11.4% (n = 12), most of which were depression and anxiety. Seventy-five per cent of these cases were unknown to mental health services. However, immediate care staff were usually aware of the symptoms, although often unaware of their clinical significance. Prevalence of dementia was also 11.4% (n = 12), with a combined case prevalence of 21.0% (n = 22). The PAS-ADD proved a flexible interview, effective in use with people of varying linguistic level and intellectual ability: 61.9% (n = 65) of the sample were able to be interviewed, fully adequate clinical interviews being obtained with a group of 38 people whose mean IQ was only 39. In the remaining 38.1% (n = 40), diagnosis relied exclusively on informant data. Overall, the combination of subject and informant data was essential for sensitive case detection.

Aged↗
PubMed1993

Modeling the behavior and attributes of injecting drug users: a new approach to identifying HIV risk practices.

The behaviors and attributes of 503 Scottish injecting drug users were modeled using the linear structural equations program LISREL. Drug use was directly related to prison experience, sexual activity, sharing of injecting equipment, and prostitution. Although the prevalence of HIV among the sample was low (2.0%), the pattern of risk behaviors observed in the data affords potential for future spread of the virus. Harm reduction measures taken by injectors in response to the threat posed by AIDS were inversely related to drug use but, more encouragingly, directly related to awareness of the disease, treatment for drug use, and prostitution.

Awareness↗
PubMed1993

Deep femoral artery pseudoaneurysm caused by acute trunk and hip torsion.

Spontaneous pseudoaneurysm is extremely uncommon. Apparently the first case of a deep femoral artery pseudoaneurysm, caused by acute trunk and hip torsion during a golf swing, is reported. The lesion was documented by computed tomography, arteriography and surgical investigation. The present report is aimed at making known the possibility of such a complication following this and similar types of physical activity in order to enable prompt assessment and treatment of the lesion.

Aged↗
PubMed1993

[A new strategy for the classification of mental disorders: an example of a multi-dimensional model for psychopathology].

Present diagnostic classification systems stand in the way of a concurrence between events in our social lives and the biological substrates of common mental disorders. A two dimensional model is presented for common mental disorders, defined by symptoms of anxiety and depression. Although anxiety symptoms are often related to threat and depressive symptoms to loss, the two types of symptoms are not independent and often co-exist. The data from two independent studies with general practice patients in which a common standardized research interview was used were analyzed using latent trait modeling. The results obtained for the symptoms of anxiety and depression, as for the diagnoses (ICD-9 or DSM-III) confirm the robustness of this model. The strength of this conceptual model is based on its potential simultaneously to illustrate the relationship between biological and social determinants of these common symptoms. These two types of symptoms are related to the physiological reactions in response to punishment and reward. They also illustrate how certain events in our social environment are specifically associated with the constitution of anxiety and depression. Conversely, genetic vulnerability appears to be non-specific and may determine an increased overall likelihood to develop symptoms under stress, but the nature of those symptoms (anxiety or depression) depend on other factors. Moreover, other variables (i.e. personality, social relations) modify the effect of these relationships. Our knowledge of inter-relationships between common psychiatric symptoms and events from the social environment thus appears sound, and is likely to withstand future developments in biological psychiatry.

Anxiety↗
PubMed1992

A classification of psychological distress for use in primary care settings.

This paper contrasts three ways of conceptualizing emotional distress in general medical settings: high scorers on screening tests, 'cases' according to the doctor seeing them, and standardized research diagnoses. It is shown that distress as measured by screening test is very much more prevalent than research diagnosis, and yet doctors working in general medical settings need to be able to conceptualize disorders using a classification that is helpful for them. The proposed classification is based upon the patient's need for intervention, and it distinguishes the few who need to be thought of as having a formal mental disorder from the many who do not. It takes account of what is known about 'labelling' and compliance, and it is linked to the skills needed by primary care workers. The largest group consists of those whose emotional distress needs recognition and discussion; the next group also needs social interventions; while the final group benefits from recognition of a mental disorder which necessitates a medical or psychological treatment.

Depressive Disorder↗
PubMed1992

Phase I trial of interleukin-2 plus gamma-interferon.

Interleukin-2 (IL-2) and gamma interferon (gamma-IFN) may be synergistic in inducing cell-mediated antitumor cytotoxicity. In order to determine the dose-limiting toxicities and define a maximum tolerated dose of these two agents in combination, we performed a Phase I clinical trial of intravenous IL-2 plus intramuscular gamma-IFN. Patients received both agents on a thrice-weekly schedule consisting of 4 weeks of treatment followed by 2 weeks of rest. Twenty-five patients were treated and received gamma-IFN doses between 0.05-0.25 mg/m2 (1-4 x 10(6) U/m2) with IL-2 doses from 0.33 mg/m2 to 2.33 mg/m2 (6-42 x 10(6) IU/m2). Two patients had partial responses of melanoma and adenocarcinoma of the lung lasting greater than 11 and 8 months, respectively. The toxicities of the combination were those expected from each agent, with no unusual effects, no irreversible organ toxicities, and no patient deaths. The doses recommended for outpatient administration on this schedule are IL-2, 2.0 mg/m2 plus gamma-IFN, 0.25 mg/m2, a dose combination that is unassociated with significant organ toxicity.

Adenocarcinoma↗
PubMed1992

Management of somatic presentations of psychiatric illness in general medical settings: evaluation of a new training course for general practitioners.

An improved teaching package is described which aims to help general practice trainees manage somatized presentations of psychological distress. The package comprises a training videotape in which a reattribution model is demonstrated, with material for role-play of new skills and small-group video feedback of consultations. Eighteen general practice trainees attending an 8-week course in psychiatry participated fully in the somatization management teaching programme. The teaching package was evaluated by blind rating of general interview skills and model specific skills demonstrated by trainees during 10 to 15-minute clinical interviews with professional role-players. Ratings were made on pre-training and post-training videotaped interviews. A significant improvement was demonstrated in general interview skills. Improvements were also noted in specific reattribution skills post-training. The evaluation revealed that skills in the model can be effectively learned, and that improvements in the package have resulted in its improved efficacy.

Clinical Competence↗
PubMed1992

Patterns of psychiatric disorder in adopted girls: a research note.

Over a 15-year period adopted children were overrepresented in a psychiatric clinic population. The excess was seen in all age groups and there was no rise of referrals of adoptees during adolescence. Adopted boys showed the same range of disorder as all referred boys. Adopted girls were more likely than other girls to have conduct disorders. Those with conduct disorders were more likely than non-adopted girls with the same disorder to be taken into care and to be given inpatient treatment. Differences in family structure and relationships were found both between conduct disordered girls of different adoptive status and between adopted girls with conduct and other disorders.

Adolescent↗
PubMed1992

Training community psychiatric nurses for psychosocial intervention. Report of a pilot study.

Community psychiatric nurses were trained to deliver psychosocial intervention to clients with a diagnosis of schizophrenia living at home with relatives. The training package consisted of family assessment, health education, and family stress management strategies. In a 'quasi-experimental' design, a sample of families (n = 54) were recruited to either a control or experimental condition and followed up for 12 months. A number of favourable outcomes were observed in the experimental group, including improvements in the client's target symptoms, personal functioning, and social adjustment. Relatives' satisfaction with services increased and reports of their own minor psychiatric morbidity improved.

Adolescent↗