Audio-computer interviewing to measure HIV-risk behaviour.
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Computers↗
Biomedical subjects
D Goldberg
Publications and source records attributed to D Goldberg.
Selective versus universal antenatal HIV testing: epidemiological and implementational factors in policy choice.
OBJECTIVE: To develop an epidemiological basis for economic analyses of selective and universal antenatal screening strategies, and to apply it to the UK. METHODS: The prevalence of higher-risk women and the prevalence of undiagnosed infection within groups of high-risk and low-risk women was estimated from surveillance and survey data. The numbers of women tested and the numbers of infected women who would be identified by universal and selective strategies were then calculated under a range of assumptions about the identification of higher-risk women and acceptance of testing. RESULTS: In higher-risk women estimated prevalence of undiagnosed infection was between 0.06% and 2.8%, comparing well with independent estimates. In low-risk women, estimates ranged from 0.014% in London to 0.002% in the rest of the UK. If uptake among the high-risk women was the same in selective and universal strategies, universal testing would entail testing between 7100 (London) and 50000 (rest of England) additional women to detect an additional case. However, if selective screening identified only 60% of those at high risk and achieved only 60% acceptance compared with a universal programme, then universal screening would require only 1150 additional women to identify one additional case in London, compared to 6470 in Scotland and 13140 in the rest of the UK. CONCLUSIONS: Overall prevalence does not form an adequate basis for determining screening strategy. Instead, universal screening can be justified either because the prevalence of HIV in the low-risk group is sufficiently high, or because it achieves sufficiently higher uptake relative to selective screening among those at higher risk.
Female↗
The future pattern of psychiatric provision in England.
The events that led to a reduction in both the size and number of mental hospitals in the United Kingdom are reviewed, and the mental hospitals remaining are shown to be mainly providing care in specialised units. Studies of mental hospital closure have shown that care in the community is generally preferred by patients, although for the "old long stay" the total costs are broadly similar. However, for patients with new illnesses care is undoubtedly much cheaper, and patients acquire fewer secondary handicaps of their psychotic illness. Hospital beds are still needed for a community mental health service; and in inner city areas, where prevalence rates for psychotic illness are higher, there are often too few beds to run an efficient service so that patients needing admission may either not be admitted at all, or be admitted to a distant hospital. The allocation of funds for mental illness to local health authorities takes some account of socio-demographic indicators of illness, but authorities are free to spend more or less than their allocation on the mental illness service. One study suggests that there is an optimal number of beds for a given location and that costs of the service increase if there are either too few or too many beds available. It is argued that for care in the community to succeed there must be adequate numbers of beds available, a range of sheltered residential accomodation in the community, as well as enough staff to provide a service for them. Future changes to the way in which the National Health Service is funded--with resource being allocated by groups of general practitioners--make it likely that there will be a shift of resources towards primary care services.
Cost-Benefit Analysis↗
Oxygen isotope ratios of juice water in Australian oranges and concentrates.
Australian orange juices from major growing regions have been surveyed over a 5 year period with a view to establishing a database of (18)O/(16)O isotope ratios against which retail samples can be tested for authenticity. The (18)O/(16)O ratios were found to follow a consistent pattern that had both a cyclic seasonal and a regional influence. Oxygen delta values ranged from a summer maximum of >+15 per thousand for oranges from inland regions to a winter minimum of approximately +1 per thousand for oranges grown in coastal areas. However, over a shorter time period, the range of values was markedly less than this. Concentrated orange juices, pulpwashes, and peel extracts, as well as other citrus types, were also tested. The effect of some industry practices that have an effect on (18)O/(16)O ratios was also investigated.
Beverages↗
A national survey of practice nurse involvement in mental health interventions.
BACKGROUND: The move in the United Kingdom (UK) from institutional to community care has led to an inevitable increase in the involvement of practice nurses (PNs) in mental health care. Around 20 000 PNs are currently working in the United Kingdom (UK). However, the extent and nature of PN involvement in delivering mental health interventions has not been adequately explored. AIM: This study aimed to quantify practice nurses' involvement in delivering mental health interventions in primary care settings. METHOD: A questionnaire was sent to a random sample of 1500 practice nurses registered with the Practice Nurse Forum at the Royal College of Nursing. Sixty per cent of questionnaires were returned; however, once non-eligible respondents were removed an adjusted response rate of 54% was achieved. RESULTS: Practice nurses play a significant role in the assessment and treatment of mental health problems, most frequently via the administration of depot antipsychotics and the screening for depression. However, antipsychotic side-effects were infrequently monitored and PNs' understanding of treatment issues in depression is poor. These findings may be associated with the reported lack of mental health training that PNs have received. CONCLUSIONS: The findings of this study have important implications for the training of practice nurses in mental health, specifically in the areas of medication management and the detection of mental disorders.
Adult↗
Hepatitis C antibody detection in dried blood spots.
In the UK, there have been few studies of the seroprevalence of antibodies to hepatitis C virus (anti-HCV). As part of an ongoing prevalence study of HCV in injecting drug users, we have developed a technique for detecting anti-HCV in blood spots dried on filter paper using a commercially available assay. Subjects with and without serum anti-HCV were studied. The manufacturer's recommended cut-off (CO) for a positive anti-HCV result is kit-dependent, and therefore a ratio of test result (T) to kit CO was used to standardize results. T/CO values greater than 0.99 had a sensitivity of 100% and a specificity of 87.5% for anti-HCV detection. T/CO values greater than 1.99 had a sensitivity of 97.2% and a specificity of 100%. Hence, testing dried blood spots may be useful for detecting anti-HCV in epidemiological studies and as a diagnostic test in patients with poor peripheral venous access.
Blood Specimen Collection↗
Skin resurfacing utilizing a low-fluence Nd:YAG laser.
OBJECTIVE: The purpose of this clinical study was to determine the effectiveness of low fluence topical carbon suspension assisted Q-switched Nd:YAG laser treatment of fine rhytids. MATERIALS AND METHODS: Some 242 solar-damaged anatomical sites on 61 human subjects were treated with three laser treatments at two study centers. The treatment involved applying a carbon suspension to the skin surface and irradiating the exogenous chromophore with a Q-switched Nd:YAG laser. Cosmetic skin-resurfacing was accomplished using a wavelength of 1064 nm, a fluence of 2.5 J/cm2, a pulse duration of 6-20 ns, a pulse repetition rate of 1-10 Hz and a fixed beam size of 7 mm. The treatment sites were evaluated at baseline, 4, 8, 14, 20 and 32 weeks for skin texture, skin elasticity and rhytid reduction. All sites were treated at baseline, 4 and 8 weeks. Skin replicas taken prior to treatment and at the conclusion of the study were analyzed for wrinkle and cosmetic improvement using the Magiscan digital image process system. Adverse events were recorded throughout the study. RESULTS: At 8 months the investigators reported improvement in both skin texture and skin elasticity, as well as rhytid reduction compared to baseline. In self-assessments, subjects also reported noticeable skin texture and cosmetic improvement, but assessed wrinkle reduction less favorably than seen by the investigators. The majority of adverse events were limited to mild, brief erythema. CONCLUSIONS: Topical carbon suspension assisted Q-switched Nd:YAG laser treatment offers a safe cosmetic method of resurfacing solar-damaged skin. The effect, as reported by investigators and subjects in this study, and confirmed by skin replica analyses, included improvement in skin texture, elasticity and rhytid appearance.
Humans↗
Antenatal screening for hepatitis B infection and syphilis in the UK.
OBJECTIVES: To assess antenatal hepatitis B and syphilis screening policies in the UK. DESIGN: Postal questionnaire survey. SETTING: One hundred and ninety-two obstetric units and 116 Public Health directorates. MAIN OUTCOME MEASURES: Antenatal screening policy and line of responsibility for ensuring vaccine uptake in hepatitis B virus exposed children. RESULTS: Replies were received from 140 (73%) obstetric centres and 99 (85%) Public Health directors. Forty per cent of obstetric centres now offer hepatitis B virus tests to all pregnant women, and nearly one-quarter (24.1%) of all births in the UK in 1996 occurred in centres with a universal testing policy. The prevalence of chronic hepatitis B virus ranged from 0.3 to 17.5 per 1000 deliveries. Universal antenatal screening for serological evidence of syphilis was the norm, but five obstetric centres respondents and three Public Health directors were considering its discontinuation. In the nine London centres, syphilis prevalence was 2.06 per 1000 pregnant women, compared with 0.24 per 1000 elsewhere. Responses from Public Health directors indicated the nonspecific nature of the antenatal care contract. Responsibility for hepatitis B virus vaccination of the newly born infant rests with the hospital paediatrician, with transfer of responsibility to the community usually occurring through a discharge letter. Only two areas had a monitoring system to ensure full hepatitis B virus vaccination coverage of exposed infants. CONCLUSIONS: If antenatal screening policies are to be equitable there is a need for a clear national policy, and systems need to be established to monitor local policy and practice.
Female↗
Long-term outcome analysis of two treatment methods for cleft palate: combined levator retropositioning and pharyngeal flap versus double-opposing Z-plasty.
OBJECTIVE: Two surgical techniques for repair of a cleft palate include levator retropositioning in combination with a pharyngeal flap and the Furlow double-opposing Z-plasty. This study compared morbidity and speech results from the use of these two methods in an effort to determine which was the superior technique. DESIGN: Patient records from 1986 to 1996 were retrospectively reviewed, and 10 patients with a cleft palate who underwent repair with a levator retropositioning and pharyngeal flap were compared to 14 patients who underwent a double-opposing Z-plasty repair. Postoperative complications including fistula formation, obstructive sleep apnea, and residual velopharyngeal insufficiency were recorded. Speech was assessed perceptually and through the use of nasometry. RESULTS: Both surgical techniques resulted in good speech in the majority of patients. Only two patients in the study, both in the Z-plasty group, had severe postoperative hypernasality. Two patients in the levator retropositioning and pharyngeal flap group developed severe postoperative obstructive sleep apnea, requiring additional surgery. CONCLUSION: The levator retropositioning and pharyngeal flap technique was successful in achieving good speech results, but it also caused more serious postoperative complications when compared to the double-opposing Z-plasty technique.
Cleft Palate↗
Blue gourami (Trichogaster trichopterus) gonadotropic beta subunits (I and II) cDNA sequences and expression during oogenesis.
We have cloned two cDNAs from the pituitary gland of blue gourami (Trichogaster trichopterus), coding for the beta subunits of the gonadotropin hormones GtH-I and GtH-II. The two cDNAs were sequenced and subjected to sequence analysis. We have found that the deduced amino acid sequences of both cDNAs were most similar to their striped bass counterparts. The beta GtH-I subunits of blue gourami and striped bass shared 73% of their residues, and the beta GtH-II subunits 84%. The cloning of the cDNAs of beta GtH-I and beta GtH-II has enabled us to measure the expression of their respective mRNAs in the pituitaries of female blue gourami at different stages of the reproductive cycle. The highest levels of beta GtH-I and beta GtH-II mRNA were found in specimens classified as high vitellogenic and in females that were at the final stages of oocyte maturation.
Amino Acid Sequence↗
The management of anxious depression in primary care.
Patients with combinations of anxiety and depressive symptoms form the largest group in both community and primary care, yet many remain undetected by primary care physicians and relatively few are referred to mental health professionals. This review deals with 4 issues: (1) the natural history of undetected depression, showing that, although patients have a generally good outcome, there is considerable residual disability; (2) the best management for recognized cases, with evidence that patients with more severe depression benefit from antidepressant therapy and should be followed up more systematically; (3) the indications for specialist referral-suggesting that these are dependent on the skills available in the primary care team and the ease of access to mental health professionals; (4) possible roles for psychiatrists in the management of anxious depression in primary care, concluding that in the United Kingdom link workers could act as coordinators between the psychiatrist and the primary care team, thus improving the care of severely ill patients and improving access for those thought to need specialized care.
Antidepressive Agents↗
Consensus statement on the primary care management of depression from the International Consensus Group on Depression and Anxiety.
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Antidepressive Agents↗
Rotator cuff imaging using bursography coupled to helical computed arthrotomography.
OBJECTIVE: To describe a rotator cuff imaging method with high sensitivity for the detection of partial tears of the superficial surface of the rotator cuff. PATIENTS AND METHODS: 33 patients with shoulder pain and no conventional arthrography evidence of a full-thickness rotator cuff tear were investigated by bursography coupled with helical computed arthrotomography. Nine subsequently underwent surgery or bursoscopy. RESULTS: Helical computed arthrotomography disclosed an abnormality of the superficial surface of the rotator cuff in 15 patients (45.5%). In the nine patients who had surgery or bursoscopy, findings from this investigation were consistent with those from bursography plus helical computed tomography. CONCLUSION: Bursography coupled with helical computed tomography may be of assistance for the diagnosis of lesions of the superficial cuff surface, which often escape detection by ultrasonography and magnetic resonance imaging.
Bursa, Synovial↗
The impact of training in problem-based interviewing on the detection and management of psychological problems presenting in primary care.
BACKGROUND: The vast majority of mental health problems present to primary care teams. However, rates of under-diagnosis remain worryingly high. This study explores a GP-centred approach to these issues. AIM: To examine the impact of training in problem-based interviewing (BPI) on the detection and management of psychological problems in primary care. METHOD: The detection and management of psychological problems by 10 general practitioners (GPs) who had received PBI training 12 months earlier was compared with that of 10 control GPs matched for age, sex, clinical experience, and practice setting; and had originally applied for, but had not been able to attend, BPI training. Consecutive attendees at one randomly selected surgery undertaken by each GP were invited to participate in the study. Two hundred and eighty patients living in Newcastle upon Tyne met inclusion criteria and gave informed consent. The presence or absence of psychological problems was assessed using patient self-ratings on the 28-item version of the General Health Questionnaire (GHQ) and blind independent observer ratings of the brief Present State Examination (PSE). Patient satisfaction with interviews was rated using the Medical Interview Satisfaction Scale (MISS). After each consultation, the GPs (blind to subjective and observer ratings) recorded their assessment and management of the patients' problems on a Practice Activity Card (PAC). RESULTS: In comparison with control GPs, index GPs demonstrated significantly greater sensitivity in the detection of psychological problems in the GHQ-PAC ratings. The absolute decrease in misdiagnosis of GHQ cases was 9% and of PSE cases was 15%. Patients meeting GHQ criteria for caseness were more likely to be prescribed psychotropic medication by an index GP than compared with a control GP. Length of interview did not differ between the groups and mean scores on the MISS suggested that patients attending PBI-trained GPs, compared with control GPs, were as satisfied or slightly more satisfied with their consultation. CONCLUSION: In comparison with control GPs, PBI-trained GPs were better at recognizing and managing psychological disorders. The potential benefits of BPI training are discussed in light of other attempts to improve mental health skills in primary care.
Adult↗
The AIDS diagnosis--down but certainly not out.
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AIDS Serodiagnosis↗
Clinical and patient satisfaction outcomes of a new treatment for somatized mental disorder taught to general practitioners.
BACKGROUND: Patients with mental disorder presenting with medically unexplained symptoms (somatized mental disorder) are common in primary care, difficult to treat, and function poorly in their daily lives. AIM: To examine the effects on patient outcome and satisfaction of a training package for somatized mental disorder delivered to general practitioners (GPs). METHOD: A prospective study of a before-and-after training study of different cohorts of patients attending eight GPs who acted as their own controls. Patients were stratified according to their belief that the presenting medical symptom had either a partial or completely physical cause. RESULTS: One hundred and three patients in the cohort before training, and 112 patients in the cohort after training, were diagnosed with somatized mental disorder by the study GPs. After training there were significant improvements in interview-rated psychiatric disorder (P = 0.032) at one month, self-rated psychiatric disorder (P = 0.024), and global function (P = 0.020) at three months in patients who believed their symptoms to have a partial physical cause. Training at one-month follow-up reduced depressive symptoms in patients with major depression but did not significantly change any other outcome in patients who believed their symptoms had only a physical cause. There was no overall change in patient satisfaction. CONCLUSION: Training GPs clinically benefited patients with somatized mental disorder who believe that their symptoms have a partial physical cause.
Adult↗
The complete DNA sequence and genome organization of the avian adenovirus, hemorrhagic enteritis virus.
Hemorrhagic enteritis virus (HEV) belongs to the Adenoviridae family, a subgroup of adenoviruses (Ads) that infect avian species. In this article, the complete DNA sequence and the genome organization of the virus are described. The full-length of the genome was found to be 26,263 bp, shorter than the DNA of any other Ad described so far. The G + C content of the genome is 34.93%. There are short terminal repeats (39 bp), as described for other Ads. Genes were identified by comparison of the DNA and predicted amino acid sequences with published sequences of other Ads. The organization of the genome in respect to late genes (52K, IIIa, penton base, core protein, hexon, endopeptidase, 100K, pVIII, and fiber), early region 2 genes (polymerase, terminal protein, and DNA binding protein), and intermediate gene IVa2 was found to be similar to that of other human and avian Ad genomes. No sequences similar to E1 and E4 regions were found. Very low similarity to ovine E3 region was found. Open reading frames were identified with no similarity to any published Ad sequence.
Adenoviridae↗
Randomised trial of impact of school mental-health programme in rural Rawalpindi, Pakistan.
BACKGROUND: A school mental-health programme has been developed as a component of the community mental-health programme in Rawalpindi, Pakistan. It has the objective of improving the understanding of disorders of mental health in the rural community. We aimed to assess the impact of a school mental-health programme on the awareness of schoolchildren, their parents, friends who were not attending school, and neighbours. METHODS: We chose two secondary schools for boys and two for girls that were similar in terms of size, staff-pupil ratio, and drop-out rates. 100 children aged 12-16 years (25 girls and 25 boys in each of the study and control groups), 100 parents (one for each child), 100 friends who did not attend school (one for each child), and 100 neighbours (one for each child) were given a 19-item questionnaire before and after the study group had had a 4-month programme of mental-health education. The maximum score for the questionnaire was 16 points. FINDINGS: Before the school mental-health programme the awareness of mental-health issues was poor (mean score 5.7-7.6) in the four groups of participants. In the study group there was a significant improvement in the mean scores after the school programme in the schoolchildren (mean improvement 7.6 [95% CI 6.7-8.5], p<0.01), their parents (5.3 [4.5-6.1], p<0.01), friends (5.1 [4.1-6.1], p<0.01), and neighbours (3.4 [2.6-4.2], p<0.01). In the control group the difference in awareness was significant only in schoolchildren (1.5 [0.5-2.3], p=0.01) and their friends (0.8 [0.3-1.3], p<0.01). INTERPRETATION: The school programme succeeded in improving awareness of mental health in schoolchildren and the community. The schoolchildren were receptive to the programme, and shared their new understanding with family, friends, and neighbours. Mental-health planners who wish to improve community awareness of mental health, particularly in areas with low literacy rates, should consider setting up school mental-health programmes.
Child↗