Biomedical subjects
H Roberts
Publications and source records attributed to H Roberts.
The course of severe chronic fatigue syndrome in childhood.
Little has been reported on prognostic indicators in children with chronic fatigue syndrome (CFS). We used interviews with children and parents, a mean of 45.5 months after illness onset, to follow up 25 cases of CFS referred to tertiary paediatric psychiatric clinics. At its worst, the illness had been markedly handicapping (prolonged bed-rest and school absence in two-thirds); mean time out of school was one academic year. Two-thirds, however, had recovered and resumed normal activities--mean duration of illness to recovery/assessment 38 months--and none had developed other medical conditions. Recovery was associated with specific physical triggers to the illness, with start of illness in the autumn school term and with higher socioeconomic status. Severe fatigue states in children can cause serious and longlasting handicap but most children recover.
Screening for prothrombotic diathesis in family planning clinics.
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[Diagnosis of an intramyocardial hematoma via MRI after a traumatic myocardial infarct].
Traumatic cardiac lesions occur in about 30% of all traumatized patients, in most cases they are due to traffic accidents. We report a patient who suffered from a traumatic anterior wall infarction following a ski accident. Consecutively, an extended intramyocardial hemorrhage occurred. A left ventricular pseudoaneurysm was considered first by echocardiography. Using MRI, an intramyocaridal hemorrhage could be diagnosed because of a thin myocardial border surrounding the hematoma. Consecutively, the patient underwent CABG surgery as well as a resection of the intramyocardial hematoma. This diagnosis could be manifested surgically and histologically.
Psychiatric adjustment in adolescents with a history of chronic fatigue syndrome.
OBJECTIVE: To ascertain psychiatric adjustment in youngsters with a history of childhood chronic fatigue syndrome (CFS). METHOD: Subjects were 25 children and adolescents with CFS who were seen in tertiary pediatric/psychiatric clinics (mean age 15.6 years, seen a mean of 45.5 months after illness onset; 17 subjects had recovered and 8 were still ill) and 15 healthy matched controls. Youngsters and their parents (usually mothers) were interviewed and completed questionnaires. Instruments used included the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS), the Child Behavior Checklist (CBCL), and the Harter Self-Esteem Questionnaire. RESULTS: At assessment, psychiatric disorders (mainly anxiety and depressive disorders) were present in half the subjects with a history of CFS, a rate significantly higher than in healthy controls. On the CBCL youngsters with a history of CFS had an excess of psychological symptoms and decreased social competence. On the Harter Self-Esteem Questionnaire they reported reduced self-esteem, especially in social competence. Anxiety disorders were significantly more common in recovered subjects than in those with active CFS illness status. CONCLUSIONS: Psychiatric disorders were found to be increased in adolescents with a history of severe CFS; CFS may enhance the risk for or share common predisposing factors with anxiety disorders.
[Acute vascular perforation with shunt formation in the right ventricle after percutaneous transluminal coronary angioplasty. Magnetic resonance tomography and Doppler ultrasound detection of shunt flow].
A coronary artery perforation is a rare complication after percutaneous transluminal coronary angioplasty. The therapy will be determined by the hemodynamic failure of the left or right ventricle. A case of a coronary artery perforation with a shunt from the right coronary artery to the right ventricle after coronary angioplasty is reported. The shunt was detected by coronary angiography and confirmed by magnetic resonance imaging and doppler echocardiography.
Spinal bone density in women using depot medroxyprogesterone contraception.
OBJECTIVE: To determine factors possibly associated with reduced bone density in women using the injectable contraceptive depot medroxyprogesterone acetate. METHODS: In a cross-sectional study, bone mineral density of the lumbar spine was measured by dual energy x-ray absorptiometry in 200 current users of depot medroxyprogesterone acetate who had used this method of contraception for 2-26 years and compared with 350 control subjects. Bone density results are expressed as standard deviation scores (z score). RESULTS: The bone density was significantly lower in depot medroxyprogesterone acetate users (mean z score: -0.65, 95% confidence intervals [CI] -0.80, -0.49, P < .001). Bone density was significantly reduced in nonsmokers and smokers, and there was no significant difference in mean z score between smokers and nonsmokers (mean -0.75 versus -0.58, P=.30). Women who had started depot medroxyprogesterone acetate after the age of 20 years and who had used it for 15 or fewer years had a significantly higher bone density than the remainder of the cohort (mean -0.45 [95% CI -0.62, -0.27] versus -1.02 [95% CI -1.32, -0.73], P < .005). Bone density in depot medroxyprogesterone acetate users was not related to current age, parity, body mass index, calcium intake, or exercise. CONCLUSION: Depot medroxyprogesterone acetate use is associated with a significant reduction in bone density, and although a high proportion of depot medroxyprogesterone users do smoke, the reduction in bone density cannot be explained by smoking. Women who use it for a long time and those who start it before peak bone mass is attained may be at highest risk.
[Flow quantification of intracardiac shunt volumes using MR phase contrast technique in the breath holding phase].
PURPOSE: Comparison of a breath-hold, velocity-encoded, phase-difference magnetic resonance (MR) sequence for intracardiac shunt flow measurement with the invasive shunt size determination by oximetry. PATIENTS AND METHODS: 10 patients with different cardiac shunts (6 ASD/3 VSD/1 PDA) and four healthy individuals were investigated using a 1.5 Tesla Siemens Vision system. For flow measurements a breath-hold, velocity-encoded, phase-difference magnetic resonance (MR) sequence was used ('through plane', FLASH 2D-sequence, TR/TE 110/5 ms, 'velocity encoding' 250 cm/s). Mean flow (ml/R-R interval) in the ascending aorta, the pulmonary trunk, and the right and left pulmonary arteries was determined. The ratio of the mean flow in the pulmonary circulation (Qp: sum of the mean flows in the right and left pulmonary arteries) and the systemic circulation (Qs: mean flow in the proximal aorta) was compared with the Qp/Qs ratios determined by the invasive oxymetric technique. Oximetry was performed within 24 hours after MR imaging. RESULTS: In the 4 healthy individuals MR flow measurement yielded a Qp/Qs ratio of 0.96 +/- 0.15. In the 10 patients with the various shunt defects, the non-invasive shunt determination by MR gave a Qp/Qs ratio of 2.09 +/- 0.67. The percentage of the calculated shunt sizes was 47.05 +/- 17.45%. In the comparison with the results determined by the invasive oxymetric technique, the MR data showed a strong correlation of r = 0.87. CONCLUSIONS: Breath-hold, velocity-encoded, phase-difference MR-technique enables a reliable quantification of cardiac shunts within a short acquisition time.
Clinical experience with recombinant factor VIIa.
Recombinant factor VIIa (rFVIIa) represents a major therapeutic advance in the treatment of haemophilia patients with inhibitors. The efficacy and safety of rFVIIa has been extensively studied in over 1900 surgical and non-surgical bleeding episodes in over 400 patients with haemophilia A or B (with or without inhibitors) or acquired haemophilia. Of 103 evaluable surgical bleeding episodes, the response to treatment with rFVIIa was considered to be either excellent or effective in 81%, 86% and 92% of major, minor and dental bleeding episodes, respectively. Treatment has been evaluated in 518 serious bleeding episodes and the response was considered either excellent or effective in 62% of muscle, 80% of ear, nose and throat, 88% of central nervous system, 76% of joint, and 75% of internal or retroperitoneal bleeding episodes. An excellent safety profile has also been demonstrated: of 1957 treatments with rFVIIa, only 16 serious adverse events have been reported that were considered to be possibly, but not necessarily, related to treatment.
Ectopic pregnancy in lower segment uterine scar.
A case of ectopic pregnancy in a lower uterine segment scar following previous Caesarean section is reported. A significant scar defect may result in deep implantation within the myometrium with the risk of persistent pain and bleeding followed inevitably by uterine rupture. In this report we discuss a number of management options. Except in the special situation of superficial implantation in a shallow scar defect where there is ultrasound evidence of continuity of the gestational sac with the uterine cavity we would strongly advise termination of the pregnancy.
Socioeconomic determinants of health. Children, inequalities, and health.
This article describes a growing body of evidence showing the adverse effects of the widening income gap on the health and welfare of children and young people. The effects of this go well beyond morbidity and mortality and can also be seen in the areas of crime, violence, and educational attainment. There is a need for evidence based policy in this area, but meanwhile there is scope for intervention in pregnancy and the early years, and good evidence that this is effective. A number of well evaluated interventions not necessarily directly related to health, such as early learning programmes and social support for parents, promise to have beneficial health effects.
Assessing social work effectiveness in child care practice: the contribution of randomized controlled trials.
This article discusses the role of randomized controlled trials (RCTs) in evaluating the impact of social work interventions with children. While recognizing the difficulties of applying RCTs to all aspects of practice, we argue that controlled trials can provide the most convincing evidence of the impact of social work activities on the welfare of children and families. Accumulating evidence of the effectiveness of interventions, we propose, should constitute the core business of social work research. To this end, it is necessary to recognize the primacy of the randomized controlled trial in exploring the relationship between social work activities and client outcomes.
Qualitative research methods in interventions in injury.
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Unemployment and health: the quality of social support among residents in the Trent region of England.
OBJECTIVE: To examine the quality of social support among unemployed residents in Trent, England. DESIGN: Secondary analysis of data generated by those of working age drawn from a postal lifestyle survey of the adult population of Trent region. SUBJECTS AND SETTING: Subjects were 6987 individuals (males 16-64 years and females 16-59 years of age), of whom 9.9% (689/6987) were unemployed. MAIN OUTCOME MEASURES: Responses about the quality of social support obtained from three key questions. RESULTS: Generally, the unemployed reported poorer quality of social support than employed persons (p < 0.0001) on all three key elements examined: 31% v 17% respectively had no practical support; 19% v 10% had no help with solving problems, and 21% v 10% had no emotional support. Only 57% of the unemployed had all three of these elements compared with 75% of the employed. Unemployment and lack of social support had independent and deleterious effects on perceptions of general health and mental health. Relationships remained after allowing for the possible confounding effects of age, gender, and household composition. CONCLUSIONS: There is a relationship between unemployment and poorer quality of social support which may help to explain some of the increased morbidity and mortality experienced by this group, especially that related to mental health.
Lifestyle surveys--the complete answer?
STUDY OBJECTIVES: These were as follows: to study incompleteness of data, herein called item non-response, generated by a self completion questionnaire; to identify the characteristics of item non-responders and the types of questions liable to high item non-response rates; and to discuss possible reasons for item non-response. DESIGN: Item non-response patterns in 12,307 responders (62%) to a representative postal survey based on a stratified sample drawn from family health services authorities' (FHSA) registers were investigated. MAIN OUTCOME MEASURES: Data were analysed for item non-response in three groups depending on when the questionnaire was returned (wave analysis). The overall completion rate of the questionnaire was examined and the natural logarithm of the proportion of completed questions was used as an outcome variable in multiple regression analysis. Item nonresponse to key questions and questions of different types was examined. RESULTS: Wave analysis: the overall completion rate of the questionnaire was 86% in questionnaires returned before the first reminder and 83%-84% in those sent back after subsequent reminders. Overall pattern of item non-response; respondents failed to complete a mean of 15% and a median of 10% of the questionnaire. All questions in the questionnaire had some item non-response, ranging from 1% to 85%. Completion rates were associated with gender, age, indicators of lower socioeconomic status, and general health status. Individual questions: particular types of questions were liable to have higher item non-response, for example, linked binary questions. CONCLUSIONS: Item non-response in population postal surveys is likely to present problems in the interpretation of data by introducing bias additional to that of total non-response. Item non-response does not increase greatly with later returns, suggesting that the quality of data across responses generated by two reminders is similar. There are obstacles to reducing item non-response, such as respondent error or socioeconomic and health characteristics of the general population, that cannot be totally overcome. However, the evidence that individuals tend to complete only options within questions that apply to them and their positive behaviour is useful information for those designing questionnaires and interpreting survey data.
Family planning needs and STD risk behaviours of female psychiatric out-patients.
BACKGROUND: There are few studies concerning the family planning needs of female chronic psychiatric patients. We aimed to determine the contraceptive needs and sexually transmitted disease (STD) risk-behaviours of female psychiatric out-patients. METHOD: Sixty-six female out-patients with major psychiatric disorders, including schizophrenia, bipolar disorder and mood disorders, completed a semi-structured interview (response rate = 63%) and were individually matched for age and ethnicity with 66 women who had never been treated for psychiatric illness. They answered questions on child-rearing and on their methods of contraception in relation to their attitudes towards pregnancy, as well as on their risk for STDs. RESULTS: Compared with controls, the female patients reported having had significantly more induced abortions and were significantly more likely to have given up their own children for others to raise. Heterosexually active psychiatric patients were significantly more likely than controls to have had more than one male sexual partner, to have been pressured into unwanted sexual intercourse, and to report having had sexual intercourse with a suspected bisexual over the preceding year. CONCLUSIONS: These results underscore the priority for developing programmes that reduce female psychiatric patients' risk for unwanted pregnancies and STDs.
The relationship between intraoperative contamination of the lower respiratory tract and postoperative chest infection.
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