The Psychiatric Assessment Schedule for Adults with Developmental Disability (PAS-ADD) is a semi-structured interview for use with respondents who have learning disability and for key informants. This report investigates the ability of the instrument to detect symptoms that had been found to exist during routine clinical assessment of the patients. Field trials involved 95 referred patients with learning disability and a key informant for each sample member. Clinical opinions of the referring psychiatrists were sought using a symptom checklist. Referrer checklist symptoms and PAS-ADD data were both factor analysed. Validity testing involved (a) computation of correlations between PAS-ADD factors and checklist data and (b) comparison of PAS-ADD and referrers' diagnoses. Results indicated good validity for the PAS-ADD in relation to psychotic symptoms and depressive symptoms. Anxiety symptom identification was not well validated, probably due to small numbers. Expansive mood identified by the referrers was not detected by the PAS-ADD because there is currently no corresponding section in the interview. Where the PAS-ADD produced a diagnosis (in 58 members of the sample), 44 were in agreement with the referrer. Probability of diagnosis by PAS-ADD increased with the number of relevant active symptoms identified by the referrer. The PAS-ADD has been shown in a previous report to have the sensitivity to detect mental disorders not known to psychiatric services. For psychotic and depressive conditions, our results showed that symptom detection was in good agreement with the information provided by the referring psychiatrists on their patients. The PAS-ADD needs a section on hypomania and further investigation of its detection of anxiety disorders.

Adolescent↗

PubMed1997

Effects of cyclical etidronate therapy on bone loss in early postmenopausal women who are not undergoing hormonal replacement therapy.

This study was carried out to investigate the effectiveness and tolerability of cyclical etidronate therapy in the prevention of bone loss occurring in early postmenopausal women who are not undergoing hormone replacement therapy (HRT). A total of 109 Caucasian women aged 45-60 years were treated with etidronate 400 mg/day or placebo for 14 days followed by calcium supplementation 500 mg/day for 77 days. Ninety-one women completed the 2 years of the study. After 2 years, the estimated difference between the two groups as regards lumbar spine bone mineral density (BMD) was 2.53% (SEM 1.07%; p = 0.01); BMD of the hip and wrist were not significantly different between treatment groups. A clear reduction in bone turnover was obtained as evidenced by a significant decrease in serum alkaline phosphatase level and in urinary N-telopeptide/ creatinine ratio in the etidronate group; the difference between the two groups was -12% +/- 3.2% for serum alkaline phosphatase level (p = 0.019) and -22.9% +/- 13.7% for the urinary N-telopeptide/creatinine ratio (p = 0.047). There was no statistically significant difference between the two groups in terms of the serum osteocalcin levels and urinary hydroxyproline/ creatinine and calcium/creatinine ratios. Etidronate was generally well tolerated and its adverse event profile was similar to that of placebo. The results of this study indicate that cyclic etidronate therapy can prevent trabecular bone loss, with no deleterious effect on cortical bone, in the first 5 years of menopause and that it has a very high safety margin.

Alkaline Phosphatase↗

PubMed1997

Poly[allylamine hydrochloride] (RenaGel): a noncalcemic phosphate binder for the treatment of hyperphosphatemia in chronic renal failure.

Dietary phosphate restriction and the oral administration of calcium and aluminum salts have been the principal means of controlling hyperphosphatemia in individuals with end-stage renal disease over the past decade. Although relatively well-tolerated, a large fraction of patients treated with calcium develop hypercalcemia, particularly when administered concurrently with calcitriol, despite a lowering of the dialysate calcium concentration. We evaluated the efficacy of cross-linked poly[allylamine hydrochloride] (RenaGel; Geltex Pharmaceuticals, Waltham, MA), a nonabsorbable calcium- and aluminum-free phosphate binder, in a randomized, placebo-controlled, double-blind trial of 36 maintenance hemodialysis patients followed over an 8-week period. RenaGel was found to be as effective as calcium carbonate or acetate as a phosphate binder. The reduction in serum phosphorus was significantly greater after 2 weeks of treatment with RenaGel (6.6 +/- 2.1 mg/dL to 5.4 +/- 1.5 mg/dL) compared with placebo (7.0 +/- 2.1 mg/dL to 7.2 +/- 2.4 mg/dL; P = 0.037). There was no significant change in serum calcium concentration in either treatment group. The total serum cholesterol and low-density lipoprotein cholesterol fraction were significantly reduced in RenaGel-treated patients compared with placebo-treated patients (P = 0.013 and P = 0.003, respectively) without a concomitant reduction in high-density lipoprotein cholesterol (P = 0.93). There was no difference among recipients of RenaGel and placebo in terms of adverse events. RenaGel is a safe and effective alternative to oral calcium for the management of hyperphosphatemia in end-stage renal disease.

Adult↗

PubMed1997

A comparison between somatic symptoms with and without clear organic cause: results of an international study.

BACKGROUND: The aim of this study was to determine differences between patients attending primary-care clinics with somatic symptoms for which no organic cause can be found, and those with a clear organic basis for their complaints. METHODS: Physical and psychiatric morbidity was measured in 5447 subjects presenting for primary care in 14 countries. Subjects were recruited using a two-stage design from 26,969 consecutive attenders and 25,916 (96.5%) subjects were successfully screened using the General Health Questionnaire (GHQ-12). The response rate for the second-stage assessment was 63% and consisted of the Composite International Diagnostic Instrument adapted for use in primary care (CIDI-PHC), the 28-item GHQ, the Groningen Social Disability Schedule (GSDS) and GP ratings to assess physical psychiatric and social status. Patients who reached the threshold for the number of somatic symptoms (five or more symptoms) were then divided into two groups on the basis of whether their somatic symptoms were medically explained or not. RESULTS: The presence of somatic symptoms, irrespective of aetiology, was associated with increased social and psychiatric morbidity. In the case of non-medically explained symptoms there was a clear linear relationship while with medically explained symptoms psychiatric morbidity rose sharply in the presence of more than 11 symptoms. Patients who had five or more non-medically explained symptoms were significantly younger, had greater psychiatric morbidity, were at greater risk of harmful use of alcohol and reported greater social disability than those with a medical explanation for their somatic symptoms. Patients who had an excess of somatic symptoms in both categories had especially high rates of social and psychiatric morbidity. CONCLUSIONS: These results show a strong association between somatic symptoms irrespective of aetiology and psychiatric morbidity across disparate cultures.

Adolescent↗

PubMed1997

The care of patients with chronic schizophrenia: a comparison between two services.

BACKGROUND: There has been a widespread development of community multi-disciplinary teams aimed to deliver coordinated comprehensive mental health care, yet there is little published evidence on the quality of care and economics of providing such care for people with severe mental illness. METHOD: This is a clustered randomized controlled economic comparison of the quality of care for patients with chronic schizophrenia by a multi-disciplinary community team with close links with primary care, and a traditional psychiatric service in a district general hospital psychiatric unit. RESULTS: Two years after it was established, patients with access to the community team had more of their needs met; they had fewer unmet needs; and they were more satisfied with the care they had received. They had more service contacts and received more interventions. The community team resulted in savings in the use of some hospital resources but these were not sufficient to offset the cost of the new service. The community team successfully directed care to patients with more needs, whereas no such relationship was evident for the traditional hospital-based service. Four years after the team was established, it met a greater proportion of needs for underactivity, daily living skills, use of public amenities and managing finances. CONCLUSIONS: Better quality care was provided at 2 and 4 years after its establishment by the multi-disciplinary community service than the traditional hospital-based service. Resources were targeted more efficiently by the community service.

Adult↗

PubMed1997

A comparison of resource costs for head and neck reconstruction with free and pectoralis major flaps.

A series of 178 immediate reconstructions with regional or distant tissue for repair of oropharyngeal defects caused by treatment of head and neck cancer was reviewed to determine whether reconstruction with free flaps was more or less expensive than reconstruction with regional myocutaneous flaps. In this series, three types of flaps were used: the radial forearm free flap (n = 89), the rectus abdominis free flap (n = 56), and the pectoralis major myocutaneous flap (n = 33). Resource costs were determined by adding all costs to the institution of providing each service studied using salaried employees (including physicians). The two free-flap groups were combined to compare free flaps with the pectoralis major myocutaneous flap, a regional myocutaneous flap. Failure rates in the two groups were similar (3.0 percent for pectoralis major myocutaneous flap, 3.4 percent for free flaps). The mean costs of surgery were slightly higher for the free flaps, but the subsequent hospital stay costs were lower. Therefore, the total mean resource cost for the free-flap group ($28,460) was lower than the cost for the myocutaneous flap group ($40,992). The pectoralis major myocutaneous flap may have been selected for more patients with advanced disease and systemic medical problems, contributing to longer hospitalization and added cost. Nevertheless, this study suggests that free flaps are not more expensive than other methods and may provide cost savings for selected patients.

Age Factors↗

PubMed1997

Who goes to sexually transmitted diseases clinics? Results from a national population survey (Genitourin Med 1996; 72:197-202)

Explore the source record for details and available documents.

Ambulatory Care Facilities↗

PubMed1997

Anonymous HIV surveillance with risk-factor elicitation: at Perth (for men) and Cornton Vale (for women) prisons in Scotland.

434 male and 145 female prisoners were available to participate in cross-sectional, voluntary anonymous HIV surveillance (using saliva samples) with linked self-completion questionnaire at HMP (Her Majesty's Prison) Perth on 17 May and at HMP Cornton Vale on 18 May 1995. Three hundred and four men (70%) and 136 women (94%) completed a risk-factor questionnaire and 304 and 135 samples were received for HIV antibody testing. Two hundred and eighty-two and 132 questionnaires passed logical checks. Six saliva samples from Perth (all injectors) out of 304 and none from Cornton Vale out of 134 tested were HIV antibody positive. Four were presumptively from known HIV-infected male inmates; the other 2 were local men, under 26 years, who began injecting in 1989-91, and both reported having had a recent HIV test. Overall HIV prevalence was estimated at 2% compared to a known prevalence of 1.4% (6/434), giving a 1.5 ratio of overall: disclosed HIV prevalence at HMP Perth. HIV prevalence was estimated at 7% (6/82) for injector-participants and 14% (5/35) for local injector participants. At Cornton Vale, where both known HIV-infected inmates abstained, overall and disclosed HIV prevalence, were equal at 1.4%. At Perth Prison, 29% of prisoners had injected drugs (82/278); 85% of injector-inmates reported having injected inside (some prison and 31% (25/80) had started to inject while inside, 7 during their present sentence. Of all 21 injector-inmates who first injected after 1991, 10 had started to inject inside, including one of 69 male inmates who had never been inside before. The corresponding figures for Cornton Vale, where 46% of inmates were injectors (58/132), were that 57% of injector-inmates had injected inside (32/56) but only one woman, for whom this was not her first sentence, had started to inject inside. Twenty-eight per cent of male prisoners (78/277) and 57% of male injector-inmates (47/82) had had a personal HIV test since January 1993, as had 35% of female prisoners (43/124) and 57% of female injector-inmates (30/53). A much higher proportion of Glasgow's female prisoners (64%: 38/60) were injectors than of women prisoners from the Edinburgh, Dundee and Fife area (21%: 5/26) or from elsewhere (34%: 15/45). Rape was reported by 23% of women (30/130). Women who had been raped had a more polarized distribution of male sexual partners (none to 2 plus) in the year before sentencing than other women and were more likely to report anal sex (11/30 vs 11/100, P < 0.001). Prostitution had been engaged in by 19% of female injector-inmates (11/57) and was acknowledged by one other woman. However, only 5% of women (6/130) reported ever having been treated for an STD.

Adult↗

PubMed1997

Mortality and survival among a cohort of drug injectors in Glasgow, 1982-1994.

There has been much speculation about the nature and extent of mortality among drug injectors in Glasgow. In order to determine injectors' mortality rate and compare this rate to the general population, identifier information from 459 drug injectors who received treatment for drug misuse in Glasgow between 1982 and 1994 was linked to the Scottish Mortality Register. The average duration of follow-up from cohort entry was 5.5 years and 10.2 years from commencement of drug injection. By the end of 1994, 53 cohort members had died. The average annual mortality rate of 1.8% was the same as that observed in a London cohort followed-up from 1969 to 1991. However, the excess mortality ratio (EMR) of 22.0 was almost double the London rate (11.9) because of the much lower average age of mortality (26.3 vs. 38.2 years). There was no significant time trend in EMR. Kaplan-Meier hazard analyzes show that younger patients and those who were HIV positive had significantly elevated mortality rates. The main cause of death was overdose, although it is unclear how many were accidental and how many intentional. Three of the six fatalities among HIV positive injectors were AIDS related. This study enables the first realistic assessment of the hypothesis that drug-related deaths in Glasgow are especially high. In relation to other populations of drug injectors, the annual mortality rate is comparable, although the average age of mortality is much lower in Glasgow. Consequently, in comparison to the general population, the mortality rate of drug injectors is higher in Glasgow compared to other cities.

Adolescent↗

PubMed1997

Mental health care training priorities in general practice.

BACKGROUND: Mental health problems constitute a large part of general practitioners' (GPs') work, for which they may have received little training beyond their undergraduate education. They continue to find themselves criticized in the literature over inadequate recognition and management of these problems. While there is concern about the effectiveness of continuing medical education (CME), educational needs assessment can improve the outcome of CME programmes. AIM: To assess GPs' perceived educational needs regarding mental health problems. METHODS: A questionnaire was developed, piloted and posted to GPs (n = 380) in the Lambeth, Southwark and Lewisham Family Health Services Authority (FHSA) area in south-east Thames. In addition to demographic data, the questionnaire asked practitioners to select from a list of 26 mental health topics those in which they would like further training, their preferred educational formats and timetabling, and willingness to attend for training. Two postal reminders were sent to non-respondents. Data were analysed using SPSS. RESULTS: Altogether, 62% (237/380) of the GPs responded. The range for the number of topics selected was from zero to 26 and the mode was 5. Most frequently selected topics were psychiatric emergencies, somatization, counselling skills, 'heartsink' patients, psychosexual problems and stress management, each of which was chosen by at least 40%. Small group work alone, and allied to a lecture, was rated as the most useful educational format. In all, 74% (175/237) indicated that they would be interested in attending a half-day training course. CONCLUSION: These results suggest that GPs working in the inner city recognize the importance of improving their skills in the care of mental health problems, and indicate which topics are regarded as the most important and suitable for educational interventions. A needs-led approach to continuing medical education of this kind will help to plan CME programmes relevant to GPs' needs.

Adult↗

PubMed1997