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Biomedical subjects

D Goldberg

Publications and source records attributed to D Goldberg.

At least 163 records · Page 9Linked to original sources
PubMed1994

Cost-effectiveness in the treatment of patients with schizophrenia.

Three sorts of economic studies have addressed the treatment of schizophrenia. Studies of the total costs of the illness to whole communities have examined the economic effects of changes in both the illness and its treatment; naturalistic studies of cohorts of patients have addressed relationships between costs, needs and clinical outcomes; and randomized controlled trials of various kinds of community care and traditional care have produced data on the relative cost effectiveness of the new treatments. The Madison model of training in community living is generally cheaper for society than traditional care, consistently produces better satisfaction and, in some studies, has produced better clinical outcomes as well. Other models of care have produced similar outcomes at lower cost. A study that includes home-based rehabilitation for patients with established schizophrenic illness has produced better outcomes at similar costs. In general terms, cost savings are achieved by shortening the length of stay in hospital. Day care--often preceded by a short admission--has been shown to be cost-effective as an alternative to traditional hospitalization. The results of randomized control trials cannot be generalized to all those needing acute admission to hospital, since all studies have excluded many patients from the trials. There is some evidence that higher community costs are associated with better outcomes.

Activities of Daily Living↗
PubMed1994

A bio-social model for common mental disorders.

It is argued that two major symptom dimensions underlie common mental disorders. These are depression related symptoms on the one hand, and anxious symptoms on the other. Each of these symptom dimensions is relate to a set of social variables, but an individual patient may have social factors present that are associated with each symptom dimension, thus producing an overlapping of symptoms. Another reason why the symptom dimensions overlap is that depression and anxiety relate to reward and punishment systems respectively, and these systems are necessarily reciprocally related to one another. Finally, each of these systems is related to abnormal activities in both nor-adrenergic and 5-hydroxytryptaminergic neurones. It is argued that in order to produce a useful model for common disorders one should distinguish between three groups of factors: those producing vulnerability to anxious or depressive symptoms, those factors releasing symptoms at a particular time, and those factors which determine how long illness lasts. These three groups of factors are respectively called vulnerability, destabilisation and restitution.

Adaptation, Psychological↗
PubMed1994

The outcome of training community psychiatric nurses to deliver psychosocial intervention.

BACKGROUND: A prospective quasi-experimental design was used to evaluate the effect of training CPNs to undertake psychosocial intervention with families caring for a relative with schizophrenia. METHOD: Patients meeting predetermined criteria were allocated to either an initial waiting-list control group or a delayed intervention group. The CPNs were trained to offer family interventions to a total target group of 48. Treatment was eventually accepted by 85%, of whom 81% (n = 34) were followed-up for 12 months. Families received a weekly mean session of 47 minutes (compared with 33 minutes in the controls). The main outcome measures are frequency and severity of symptoms (KGV), social functioning (SFS) and days in hospital. Carers' minor psychiatric morbidity (GHQ) and knowledge (KASI) are also reported. RESULTS: In the patient group both the positive and negative symptoms of schizophrenia improved significantly (P < or = 0.001 and P < or = 0.01 respectively) to 12-month follow-up, as did a global measure of social functioning (P < or = 0.001). Tentative evidence was also collected that family intervention reduced in-patient episodes. Benefits for relatives included a decrease in minor psychiatric morbidity (P < or = 0.05) and an increase in knowledge about neuroleptic drugs (P < or = 0.001). CONCLUSIONS: The study offers some evidence that CPNs can be taught to improve the outcome for families who care for a relative with schizophrenia.

Activities of Daily Living↗
PubMed1994

In vitro activity of readily available household materials against HIV-1: is bleach enough?

This report describes experiments assessing the effectiveness against HIV of potential disinfecting agents that are commonly available to IDU when they are sharing syringes. We exposed cell-free HIV, HIV-infected cells, and HIV-infected blood containing known quantities of HIV to household cleaning agents, alcohols, peroxide, and highly acidic materials for 1 min, in order to examine the effects of these materials on the infectivity of the HIV. Undiluted liquid laundry bleach and dilute liquid dish detergent reduced the number of culturable HIV to an undetectable level under the experimental conditions used. Diluted bleach was not completely effective. Other potential disinfecting agents, including ethanol, isopropyl alcohol, and hydrogen peroxide, were unable to disinfect high numbers of HIV-infected cells or infected blood. Liquid dish detergent warrants further study as a possible acceptable alternative to bleach. Our data provide support for recommendations to IDU that they disinfect shared syringes every time between users with full-strength liquid laundry bleach to reduce their risk of acquiring or transmitting HIV. When bleach is not available, liquid dish detergent or other available disinfecting agents such as rubbing alcohol, hydrogen peroxide, or high alcohol content beverages are more effective than water at disinfecting HIV, recognizing that these materials are less effective than bleach. Although these materials are effective, they should not be viewed as a substitute for decreased sharing of injection equipment by IDU, or increased availability of sterile needles and syringes.

1-Propanol↗
PubMed1993

Vertically transmitted HIV infection in the British Isles.

OBJECTIVE: To describe the epidemiology of vertically acquired HIV infection in the British Isles, the level of underreporting, the vertical transmission rate, and clinical spectrum of paediatric AIDS. DESIGN: Confidential, linked registers based on reporting from obstetricians and paediatricians; anonymous unlinked neonatal HIV serosurveys. SETTING: British Isles. SUBJECTS: Children born to mothers with HIV infection. MAIN OUTCOME MEASURES: Trends in HIV infection and vertical transmission rate. RESULTS: In Scotland and the Irish Republic, where most maternal HIV infection is related to drug misuse, the annual number of reports of children born to infected mothers has fallen since 1989. In England and Wales nearly half of maternal infections have been acquired overseas, and the number of children born to these women, and to women who became infected in Britain, is increasing. In south east England the proportion of live births to women whose infection was identified before delivery was only 17% (50/287), compared with 68% (26/38) in Scotland. The vertical transmission rate was 13.7% (23/168), and 23% of infected children developed AIDS in the first year of life. 41% (38/92) of children born to infected mothers who were ascertained after delivery were breast fed, compared with 5% (12/236) of those ascertained before delivery. CONCLUSIONS: The incidence of vertically transmitted HIV infection is increasing in England and Wales. More extensive antenatal testing would enable infected women to be counselled against breast feeding, which could prevent a substantial proportion of vertical transmission in some areas, and would increase opportunities for early diagnosis and treatment of infected children.

AIDS-Related Opportunistic Infections↗
PubMed1993

A Candida albicans homolog of CDC25 is functional in Saccharomyces cerevisiae.

We have cloned, by functional complementation of the cdc25-2 mutation of Saccharomyces cerevisiae, a homolog of CDC25 from the pathogenic yeast Candida albicans. The new gene, named CSC25 codes for a 1333-amino-acid protein. The full length gene, as well as a truncated form coding for 795 amino acids, suppresses the thermosensitive phenotype of cdc25ts mutants. Biochemical analysis has shown that Csc25 activates the Ras/adenylyl cyclase pathway in S. cerevisiae at a rate two to three times faster than Cdc25, under the same conditions. The C-terminal domain of Csc25 is highly similar to the C-terminal domain of Cdc25, to almost the same extent as the C-terminus of the endogenous Cdc25 homolog Sdc25. We show that polyclonal anti-Cdc25 antibodies interact with Csc25 expressed in S. cerevisiae. In addition to the full length protein (approximately 150 kDa), we have found a approximately 50-kDa polypeptide which seems to include the C-terminus of the CSC25 gene product.

Amino Acid Sequence↗
PubMed1993

An international study of psychological problems in primary care. Preliminary report from the World Health Organization Collaborative Project on 'Psychological Problems in General Health Care'.

This article describes a large longitudinal multicenter collaborative study that investigated the form, frequency, course, and outcome of psychological problems that were seen in primary health care settings in 15 different sites around the world. The research employed a two-stage sampling design in which the 12-item General Health Questionnaire was administered to 26,422 persons aged 18 to 65 years who were consulting health care services. Of these persons, 5604 were selected for detailed examinations using standardized instruments and were followed up at 3 months and 1 year to provide information on course and outcome. All assessment instruments have been translated into 13 different languages. The project has produced a database that allows for the exploration of the nature of psychological disorders experienced by patients in general medical care and their association with physical illness, illness behavior, and disability over time.

Adolescent↗
PubMed1993

The therapeutic use of social disturbance in institutions: a sociological approach in practice.

Disturbances periodically occur in psychiatric Adolescent Units. This paper argues that by delaying full resolution of these social disturbances, maximum therapeutic benefit may be gained. Illustrated by clinical example, this paper shows how prolonging complete resolution can effect change for the adolescent, the adolescent's social network, and the Adolescent Unit itself. This phenomenon is explained in terms of the philosophy and social structure of the Adolescent Unit described, using methods taken from sociology.

Adolescent↗
PubMed1993

Physical morbidity in older people with moderate, severe and profound mental handicap, and its relation to psychiatric morbidity.

This report describes a study of physical health problems and their relation to psychiatric morbidity in a community sample of 105 people with severe mental handicap and over the age of 50 years from a Metropolitan Borough. An extensive outreach exercise ensured that almost 100% of people fulfilling the age and ability criteria were included in the study. All the physical and mental health assessments were carried out by a psychiatrist at senior registrar level. Physical assessments used a combination of physical examination and access to the subject's medical records. Results showed that, with minor exceptions, the physical health of the handicapped population was no worse than that of controls. Contrary to expectation, no relationship was demonstrated between physical and psychiatric morbidity. However, this may be due to the greater difficulty in identifying psychiatric morbidity in people who are more severely handicapped. Since physical health problems increase with level of handicap, the potential relation between physical and mental health is masked.

Aged↗
PubMed1993

HIV testing among injecting drug users in Glasgow.

The use of saliva rather than blood for epidemiological studies of HIV prevalence, especially among injecting drug users, has several practical advantages. In a cross-sectional, behavioural and prevalence study among drug users in Glasgow during 1990, salivary samples were therefore obtained by the use of salivettes. Such samples were requested for anonymous anti-HIV testing from 498 persons in locations varying from residential rehabilitation centres to the open streets. Of this number, 35 refused to give a sample, resulting in a compliance rate of 93%. Of the 463 salivettes received by the laboratory, eight were found to be dry. Of the remaining 455 specimens, eight were found to be positive for HIV-1 antibody by means of an IgG antibody capture ELISA, so giving a prevalence rate of 1.8%. The results of testing saliva and blood spot samples collected at the same time on filter paper from 98 persons for HIV-1 antibody were 100% concordant. The study confirms the experience of others that specimens of saliva are easy to collect under variable conditions by non-medical staff and demonstrates that the salivette can provide an HIV antibody test result the same as that obtained from a blood spot. The prevalence of HIV antibody determined in this study is similar to that of other studies taking place in the city during the same period of time.

Cross-Sectional Studies↗
PubMed1993

Prison experience of injecting drug users in Glasgow.

Five hundred three injecting drug users in Glasgow recruited by a multisite and citywide sampling strategy were questioned regarding their drug-taking behaviour during episodes of custody over the six months prior to interview. Fifty-two percent had been in custody during the past 6 months, 16% of these had injected while in custody. Of these 73% borrowed injecting equipment and 78% handed on used equipment to others. All those who shared, cleaned their injecting sets before use. Over half of those who injected had a source of new sets. While the potential exists for spread of HIV among drug users while in custody there is clear understanding among them of the route by which the virus is spread and also the will to prevent it.

Cross-Sectional Studies↗