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Biomedical subjects

D Healy

Publications and source records attributed to D Healy.

At least 19 recordsLinked to original sources
PubMed2003

Isolation of a European bat lyssavirus type 2 from a Daubenton's bat in the United Kingdom.

European bat lyssavirus type 2 (EBLV-2) has been isolated once previously from a bat in the UK in June 1996. In September 2002, a Daubenton's bat (Myotis daubentonii) found in Lancashire developed abnormal behaviour, including unprovoked aggression, while it was in captivity. Brain samples from the bat were tested for virus of the Lyssavirus genus, which includes EBLV-2 (genotype 6), and classical rabies virus (genotype 1). A positive fluorescent antibody test confirmed that it was infected with a lyssavirus, and PCR and genomic sequencing identified the virus as an EBLV-2a. Phylogenetic comparisons with all the published sequences from genotype 6 showed that it was closely related to the previous isolate of EBLV-2 in the UK and suggested links to isolates from bats in The Netherlands. The isolation of EBLV-2 from a bat found on the west coast of England provides evidence that this virus may be present within the UK Daubenton's bat population at a low prevalence level.

Amino Acid Sequence↗
PubMed2003

The perceived expressed emotion in staff scale.

Recent research has highlighted the role of expressed emotion by ward staff in determining the well-being of psychiatric inpatients. Existing methods of assessing staff expressed emotion involve standardized interviews and are expensive and time-consuming. We report the development of a questionnaire measure of expressed emotion in staff as perceived by patients. In study 1, factor analysis of items administered to patients in a variety of settings led to the development of a questionnaire with three subscales: supportiveness, criticism and intrusiveness. In study 2, the test-retest reliability of the questionnaire was found to be adequate, and some evidence of concurrent validity for the scale was obtained against expressed emotion rated from staff speech samples. In study 3, the scale was shown to have good concurrent validity against the ward atmosphere scale, and scores were found to be independent of insight or experience of admission to hospital. The perceived expressed emotion in staff scale is a convenient measure, which may have utility for both research and clinical purposes.

Adult↗
PubMed2002

Inhibins/activins as diagnostic markers for ovarian cancer.

It is widely recognised that the early detection and subsequent assessment of recurrence of ovarian cancers are key steps for successful treatment. Available serum markers (e.g. CA125) are sensitive for some epithelial carcinomas (e.g. serous, endometrioid, clear cell), however, these markers are less sensitive for granulosa cell tumours and mucinous carcinomas. Serum inhibin is an ovarian product which decreases to non detectable levels after menopause, however, certain ovarian cancers (mucinous carcinomas and sex cord stromal tumours such as granulosa cell tumours) continue to produce inhibin which provides a basis for a serum diagnostic test. Studies from this and other laboratories have investigated the suitability of inhibin as a diagnostic marker by identifying which inhibin (inhibin A (alphabetaA), inhibin B (alphabetaB), free alpha subunit) or activin (betaAbetaA) form is associated with these cancers. Available data show that inhibin assays which detect all inhibin forms, i.e. assays which detect the alpha subunit both as the free form and as an alphabeta subunit dimer provide the highest sensitivity/specificity characteristics as an ovarian cancer diagnostic test. This review will discuss the data supporting these observations and show recent studies in which a new alpha subunit monoclonal antibody-based ELISA is used as a potential diagnostic test. Furthermore, based on the high sensitivity/specificity characteristics of the respective assays for the various types of ovarian cancer, the combination of the inhibin assay with CA125 detects the majority of all ovarian cancers.

Activins↗
PubMed2002

Functional effects of agents differentially selective to noradrenergic or serotonergic systems.

BACKGROUND: The diversity of pharmacological actions of antidepressants suggests that they may bring about their clinical effects by different functional means. METHODS: Twenty healthy volunteers were randomized in a cross-over design to receive 2 weeks of a clinical dose of both reboxetine and sertraline. Baseline assessments of personality were made using the Cloninger Tridimensional Personality Questionnaire and the Karolinska Scales of Personality. Daily and weekly ratings of mood (POMS and PANAS) and quality of life (SASS) were undertaken. RESULTS: Reboxetine and sertraline differed in their effects on the SASS as well as on measures of mood. Reboxetine appeared more likely to be energy enhancing; the effects of sertraline were more difficult to quantify. Personality factors, such as harm avoidance predicted the preference of subjects for these effects and the effect of being on a preferred drug had a significant impact on SASS, and ratings of moods as well as on self-assessments of personality. CONCLUSIONS: The differences reported here are consistent with the original thinking that led to the development of the SSRIs. The findings point to the need for further research on possible differential functional effects of psychotropic agents selective to different brain systems. The findings also have implications for clinical practice, in particular for maintenance treatment with antidepressants.

Adrenergic Uptake Inhibitors↗
PubMed2001

Characteristics of ovarian and uterine cancers in a cohort of in vitro fertilization patients.

OBJECTIVE: The aim of this study was to describe the features of cancers of the uterus, ovary, and other uterine adnexae in a large cohort of in vitro fertilization (IVF) patients and to thereby assist gynecologic oncologists in counseling patients with a history of infertility. METHODS: Record-linkage to population-based cancer registries was used to determine the incidence of invasive cancer in a cohort of 29,700 IVF patients. Pathology reports were made available by the cancer registries and reviewed blind to IVF treatment status. Patient information was abstracted from IVF clinic records. RESULTS: Twelve cancers of the uterus and 13 cancers of the ovary and other uterine adnexae were identified and pathology reports were reviewed for all but 1. Patients ranged in age at diagnosis from 28 to 48 years. Five cancers were diagnosed within 8 months of referral for IVF or IVF treatment; the others were diagnosed between 1 and 12 years later. The ovarian cancers were of the following histologic types: serous (4), mucinous (1), seromucinous (1), endometrioid (3), clear cell (2), and unknown type (1). A choriocarcinoma of the fallopian tube was diagnosed in a woman with a history of tubal infertility. Cancers of the uterus included endometrial adenocarcinomas (8), stromal sarcomas (2), and leiomyosarcomas (2). Ovarian cancer was diagnosed in a woman with Bloom's syndrome, a rare autosomal recessive disorder associated with increased cancer risk. CONCLUSION: Cancer cases in this large, well-defined cohort of IVF patients show a broad range of patient and tumor characteristics. We found an increased incidence of uterine sarcoma in women with a history of infertility. Increased ascertainment of preexisting cancers in the course of infertility investigations and management is to be expected.

Adult↗
PubMed2001

Perceptions of illness causation among new referrals to a community mental health team: "explanatory model" or "exploratory map"?

The health beliefs of people suffering from mental health problems are important. Such beliefs have been identified as key factors in models of health and illness behaviour, and may therefore indirectly influence clinical outcome. In addition, the increasing move towards patient-centred health care suggests that such beliefs need to be identified if a patient's perspective of his or her illness is to be addressed in the care process. Past research on health beliefs surrounding depression have concentrated on identifying "explanatory models" among the general community or among people who already have an established diagnosis of depression. This paper describes the content and status of health beliefs among people who are in the process of receiving a diagnosis. In-depth interviews were carried out with new referrals to a community mental health team (CMHT). Individuals expressed a variety of perceived causes throughout the interview. Beliefs were therefore characterised as changeable. It is argued that the concept of an "explanatory model" is too fixed to fully convey the fluid status of beliefs among this patient group. The concept of an "exploratory map" is suggested as a replacement. Such maps outline the avenues of thought which individuals explored when attempting to understand why they were currently experiencing particular psychological problems. The strength and persistence of beliefs is discussed in relation to both theoretical and clinical implications.

Attitude to Health↗
PubMed2001

Modelling suicide risk in affective disorders.

BACKGROUND: The lifetime risk of suicide in affective disorders is commonly quoted as 15%. This stems from hospital populations of affective disorders. AIMS: To model the lifetime prevalence of suicide using data on completed suicides from one English Health District and community-based rates of prevalence of affective disorders. METHODS: A secondary analysis of a primary data set based on 212 suicides in North Staffordshire was undertaken. The population rates of psychiatric morbidity were obtained from the National Comorbidity Survey. RESULTS: The model suggests a lifetime prevalence rate of suicide for any affective disorder at 2.4%, with a rate for those uncomplicated by substance abuse, personality disorder or non-affective psychosis at 2.4%, and a rate for uncomplicated cases who had no mental health service contact at 1.1%. CONCLUSIONS: Lifetime prevalence rates of suicide in subgroups of affective disorders may be lower than the traditional rates cited for hospital depression. This has implications for primary care projects designed to investigate the occurrence of and the prevention of suicide.

Cause of Death↗
PubMed2001

Psychiatric bed utilization: 1896 and 1996 compared.

BACKGROUND: The 1896 and 1996 populations of North West Wales are similar in number, ethnic and social mix and rurality, enabling a study of the comparative incidence and prevalence of service utilization over the course of a century. METHODS: We collected records on all psychiatric admissions from North-West Wales in 1894-1896 and 1996. These were assessed and diagnosed by the responsible sector area consultant. RESULTS: The data reveal substantially more patients admitted for all diagnoses in 1996. even when comparisons are restricted to detained patients. The incidence of hospitalization by detention for schizophrenia is slightly lower 1996 than in 1896 but the incidence of hospitalization is higher now than in 1996. The incidence of hospitalization by detention for non-affective disorder psychoses is the same in both 1896 and 1996 but there is a doubling of incidence of hospitalization. The incidence of hospitalization for bipolar disorders is similar in the two periods. Modern mental health services admit large numbers of personality disordered patients, where none were admitted 100 years ago. CONCLUSIONS: Factors general to changing health care and expectations and others specific to mental health would appear to have led to the increase in rates of admissions observed in the modern period.

Adult↗
PubMed2001

Disclosure of minor mental health problems: an exploratory theoretical study.

AIM: The aim of this study was to explore people's experiences, concerns and beliefs about disclosing minor mental health problems by focusing on the ways in which such disclosures are interpreted. BACKGROUND: Approximately half of people with mental health problems do not seek help. The decision to consult represents just one aspect of the process of revealing one's illness to others. People with mental health problems are known to be reluctant to reveal the existence of those problems through fear of how others might then view them. DESIGN: A qualitative approach was employed. In-depth interviews were carried out with 47 users and nonusers of community mental health services. Interviews were tape-recorded, transcribed and analysed. RESULTS: The data suggest that when people reveal minor mental health problems others interpret these in relation to a number of perceived contextual factors. These include perceptions of the severity and duration of any possible causes, the inner 'strength' of the person, the expected ability of the person to either solve or suppress the experience, and the form and context of the expression itself. The data presented included individuals who were seeking help for relatively 'minor' mental health problems (primarily depression and anxiety) and individuals who had no current mental health problems but routinely managed expressions of their own emotions. Throughout the data there appeared to be no distinct difference between these two groups other than one of the severity of psychological experience. CONCLUSION: The key elements involved in the interpretation of people's expressions of sadness were essentially the same as those involved in the interpretation of expressions of depression. An appreciation of these contextual factors influencing the interpretation and disclosure of minor mental health problems may aid the development of more person-centred mental health services and inform the content of health education in the mental health field.

Adaptation, Psychological↗
PubMed2001

Mortality in a cohort of IVF patients.

BACKGROUND: Risks associated with IVF and related assisted reproduction technologies include complications of ovarian stimulation, surgical procedures and pregnancy itself. Serious complications are uncommon but may be potentially life threatening. The aims of this study were to compare the mortality rates of women who received IVF treatment, as well as those who were referred but were not treated, with the mortality rate in the general female population, to determine the maternal mortality rate following IVF conception and to establish whether any deaths had occurred as a result of treatment complications. METHODS: Deaths were identified in a cohort of 29 700 Australian IVF patients by record-linkage with the National Death Index and a cancer registry. RESULTS: The all-cause mortality rates in IVF patients (treated and untreated) were significantly lower than in the general female population of the same age. In treated women, 72 deaths were observed and 125 deaths were expected giving an age-standardized mortality ratio of 0.58 (95% confidence interval 0.48-0.69). Two maternal deaths were identified in the 42 days of the puerperium. Complications of ovarian hyperstimulation syndrome could not be directly related to any of the deaths identified in this cohort. CONCLUSIONS: As well as providing some reassurance about the safety of IVF treatments, the findings point to the existence of a 'healthy patient effect' whereby the unhealthiest women in the population are deterred from pregnancy and infertility treatment.

Adolescent↗
PubMed2001

A tool to assess clinical signs and symptoms of localized infection in chronic wounds: development and reliability.

This paper reports on the development and testing of a tool designed to assess chronic wounds for the clinical signs and symptoms of localized infection. Thirty-one wounds were assessed by two independent nurse observers for the signs and symptoms of infection using the Clinical Signs and Symptoms Checklist. The Clinical Signs and Symptoms Checklist delineates 12 signs and symptoms of infection (i.e., pain, erythema, edema, heat, purulent exudate, serous exudate with concurrent inflammation, delayed healing, discoloration of granulation tissue, friable granulation tissue, pocketing at the base of the wound, foul odor, and wound breakdown) and their definitions. The reliability of each sign or symptom on the checklist was calculated using percent agreement and the Kappa statistic. Percent agreement ranged from 65% to 100%, and Kappa statistics ranged from 0.53 to 1.00, excluding pocketing of the wound base. The reliability estimates obtained for signs and symptoms on the Clinical Signs and Symptoms Checklist compare favorably with other data regarding interclinician agreement on wound assessment. Incorporating a structured approach to assess and monitor for wound infection, such as the Clinical Signs and Symptoms Checklist, may improve clinician skill and accuracy in identifying this condition.

Aged↗
PubMed2000

Two consecutive pregnancies during inadvertent gonadotropin-releasing hormone agonist desensitization.

OBJECTIVE: To describe two consecutive spontaneous pregnancies during luteal-phase down-regulation with a GnRH-a. DESIGN: Case report. SETTING: University-affiliated reproductive medicine unit. PATIENT(S): A 33-year-old woman with a history of failed uterine tubal reanastomosis. INTERVENTION(S): Four IVF cycles. MAIN OUTCOME MEASURE(S): Pregnancy. RESULT(S): The patient had two spontaneous pregnancies during luteal-phase down-regulation. CONCLUSION(S): Although midluteal administration of GnRH-a is not established as a treatment, there might be a beneficial effect on the endometrium via the medication's evoked gonadotropin flare.

Adult↗
PubMed2000

Should we still advise infertile couples to use (barrier) contraception before IVF down-regulation?

OBJECTIVE: To determine the outcome of spontaneous conceptions in women who received GnRH agonists during mid-luteal phase down-regulation before IVF treatment. DESIGN: Retrospective analysis of case records and study of the literature. SETTING: Two university-affiliated reproductive medicine units. PATIENT(S): Seventy-three women who conceived spontaneously after starting down-regulation with a GnRH agonist before controlled ovarian hyperstimulation. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Course and clinical outcome of pregnancies. RESULT(S): Seventy-four pregnancies occurred in 73 women who received a GnRH agonist. Of these patients, 6 (8%) had a biochemical pregnancy, 6 (8%) had an ectopic pregnancy, 21 (28%) miscarried, and 41 pregnancies resulted in successfully delivered babies; there were 2 cases of congenital abnormalities. CONCLUSION(S): These cases, together with other published data, suggest that pregnancy outcome is not adversely affected by exposure to GnRH agonist during luteal-phase down-regulation. A central register of pregnant women who received a GnRH agonist is needed.

Buserelin↗
PubMed2000

Reboxetine: its effects as measured by the Social Adaptation Self-evaluation Scale.

The determination of the outcome of treatment for depression is important both for the symptoms of depression and social functioning. The aim of this review is to evaluate the outcome of two clinical trials comparing reboxetine and fluoxetine on depressive symptoms and social functioning. These studies used both conventional measures of outcome such as the Hamilton Rating Scale for Depression (HAM-D) and the Social Adaptation Self-evaluation Scale (SASS), a patient-centred, disease non-specific scale of social functioning, which was developed for measuring social functioning in depressed people. These findings, set against a background of all studies in which antidepressants have been compared using quality of life instruments, suggest that while some patients may appear to the clinician to have recovered, they may remain less than fully well and differences in selectivity for neurotransmitter systems may play a part in the degree of wellbeing that recovered patients might expect.

Adrenergic Uptake Inhibitors↗