Biomedical subjects

J Elisabeth Wells

Publications and source records attributed to J Elisabeth Wells.

17 recordsLinked to original sources

PubMed2005

Stability and instability in alcohol diagnosis from ages 18 to 21 and ages 21 to 25 years.

BACKGROUND: Only in recent years have longitudinal studies of adolescents diagnosed alcohol use disorders and these have not distinguished between abuse and dependence. This study describes the course of disorder from age 18 to age 25 for abuse and dependence and investigates the extent to which continuities in disorder can be explained by background factors. METHODS: A birth cohort of 1,265 individuals from Christchurch, New Zealand, followed annually to age 16 years then at 18, 21 and 25 years (1,003 at age 25). DSM-IV diagnoses were made from reports of alcohol symptoms at 18, 21 and 25 years. RESULTS: The most stable diagnosis was that of no diagnosis, with 83-91% staying the same from one interview to the next. There were high rates of remission to no disorder; 57-75% for those with initial abuse and 50-54% of those with initial dependence. Nonetheless prior diagnosis was a strong predictor of subsequent diagnosis (ORs of 3.7-27.6). Adjustment for background risk factors reduced these odds ratios but all remained significant and substantial (minimum 2.6). CONCLUSIONS: The dual finding of substantial discontinuity and substantial continuity indicates that both public health and treatment interventions are warranted.

Adolescent↗

PubMed2005

Triphasic MRI of pelvic organ descent: sources of measurement error.

PURPOSE: To identify sources of error when measuring pelvic organ displacement during straining using triphasic dynamic magnetic resonance imaging (MRI). MATERIALS AND METHODS: Ten healthy nulliparous woman underwent triphasic dynamic 1.5 T pelvic MRI twice with 1 week between studies. The bladder was filled with 200 ml of a saline solution, the vagina and rectum were opacified with ultrasound gel. T2 weighted images in the sagittal plane were analysed twice by each of the two observers in a blinded fashion. Horizontal and vertical displacement of the bladder neck, bladder base, introitus vaginae, posterior fornix, cul-de sac, pouch of Douglas, anterior rectal wall, anorectal junction and change of the vaginal axis were measured eight times in each volunteer (two images, each read twice by two observers). Variance components were calculated for subject, observer, week, interactions of these three factors, and pure error. An overall standard error of measurement was calculated for a single observation by one observer on a film from one woman at one visit. RESULTS: For the majority of anatomical reference points, the range of displacements measured was wide and the overall measurement error was large. Intra-observer error and week-to-week variation within a subject were important sources of measurement error. CONCLUSION: Important sources of measurement error when using triphasic dynamic MRI to measure pelvic organ displacement during straining were identified. Recommendations to minimize those errors are made.

Adolescent↗

PubMed2005

Using a diary to quantify learning activities.

BACKGROUND: Diaries of actual learning activities can fill the gap between the planned curriculum and students' opinions and outcomes. We report the development and validity of such a method, estimate sources of variation and model sampling strategies to determine efficient ways to obtain information about a curriculum or about individual students. METHODS: Following development and piloting, the diary was administered to fourth- and fifth-year medical students. Each student was asked to complete a diary on 3 randomly selected days of the academic year. Sources of variance and generalisability were determined using variance components analysis. Validity was explored by comparing activities with what is known about the curriculum, assessment, timetables and the 2 classes of students. RESULTS: Response rate was 83% (287/345). Learning activities varied as expected with timing of assessments, and on weekdays compared with weekends. For most activities, 14 days per student would be needed to obtain generalisable information about an individual student. The variation between days is greater than the variation between students, meaning that sampling for information on a curriculum should include all students and all days of the year but the number of diaries per student could be kept low depending on the desired power to detect any differences. CONCLUSION: Such an evaluation method is feasible and can provide reliable and valid information about study activities. Reasons for good compliance are discussed. Sampling strategies should be tailored to the purpose of the study.

Attitude of Health Personnel↗

PubMed2005

Gender differences in bipolar disorder: age of onset, course, comorbidity, and symptom presentation.

OBJECTIVE: To determine whether men and women with bipolar disorder differ in age of onset, course of illness, number of suicide attempts, comorbidity rates and symptom presentation. METHOD: Data were collected from 211 (121 women; 90 men) adults using the Diagnostic Interview for Genetic Studies, medical records, and additional information gathered from relatives. RESULTS: Most gender comparisons showed no evidence of differences. Nonetheless, more men than women reported mania at the onset of bipolar I disorder. Men also had higher rates of comorbid alcohol abuse/dependence, cannabis abuse/dependence, pathological gambling and conduct disorder. Men were more likely to report 'behavioural problems' and 'being unable to hold a conversation' during mania. Women reported higher rates of comorbid eating disorders, and weight change, appetite change and middle insomnia during depression. CONCLUSIONS: Men and women were generally similar in their symptom presentation, age of onset of bipolar disorder, and in the total number of mood episodes. However, they differed in the type of episode at onset and comorbidity patterns.

Bipolar Disorder↗

PubMed2004

Randomised controlled trial of intravenous antibiotic treatment for cellulitis at home compared with hospital.

OBJECTIVES: To compare the efficacy, safety, and acceptability of treatment with intravenous antibiotics for cellulitis at home and in hospital. DESIGN: Prospective randomised controlled trial. SETTING: Christchurch, New Zealand. PARTICIPANTS: 200 patients presenting or referred to the only emergency department in Christchurch who were thought to require intravenous antibiotic treatment for cellulitis and who did not have any contraindications to home care were randomly assigned to receive treatment either at home or in hospital. MAIN OUTCOME MEASURES: Days to no advancement of cellulitis was the primary outcome measure. Days on intravenous and oral antibiotics, days in hospital or in the home care programme, complications, degree of functioning and pain, and satisfaction with site of care were also recorded. RESULTS: The two treatment groups did not differ significantly for the primary outcome of days to no advancement of cellulitis, with a mean of 1.50 days (SD 0.11) for the group receiving treatment at home and 1.49 days (SD 0.10) for the group receiving treatment in hospital (mean difference 0.01 days, 95% confidence interval -0.3 to 0.28). None of the other outcome measures differed significantly except for patients' satisfaction, which was greater in patients treated at home. CONCLUSIONS: Treatment of cellulitis requiring intravenous antibiotics can be safely delivered at home. Patients prefer home treatment, but in this study only about one third of patients presenting at hospital for intravenous treatment of cellulitis were considered suitable for home treatment.

Adolescent↗

PubMed2004

Functional assessment of bacterial colonization in patients with ileal pouch-anal anastomosis and Brooke ileostomy.

PURPOSE: This study was designed to determine whether patients with an ileal pouch-anal anastomosis have increased gastrointestinal bacterial colonization as assessed functionally compared with patients with Brooke ileostomy and to determine the effect of pouch bacterial colonization on pouch function. METHODS: Gastrointestinal bacterial colonization in 27 patients with an ileal pouch-anal anastomosis and 20 patients with a Brooke ileostomy was assessed using the 14C-glycocholate and glucose-hydrogen breath tests. Bacterial colonization was correlated with pouch function and pouch satisfaction. RESULTS: Patients with ileal pouch-anal anastomosis had increased levels of gastrointestinal bacterial colonization as measured using the 14C-glycocholate method compared with patients with Brooke ileostomy (P = 0.03). Only three patients had a positive result on the glucose hydrogen breath test, two patients with ileal pouch-anal anastomosis, and one with ileostomy; however, the ileal pouch-anal anastomosis patients did have higher levels on this test. Pouch satisfaction and pouch symptoms of urgency were not correlated with levels of bacterial colonization, whereas there was a nonsignificant trend with continence. CONCLUSIONS: We showed increased levels of gastrointestinal bacterial colonization with ileal pouch-anal anastomosis compared with Brooke ileostomy. The increase in bacteria is not limited to the pouch but also are found in the proximal small bowel. There was no correlation between bacterial colonization and urgency, continence, and pouch satisfaction. Reasons for this are discussed.

Anal Canal↗

PubMed2004

How accurate is recall of key symptoms of depression? A comparison of recall and longitudinal reports.

BACKGROUND: Assessment of lifetime major depression is usually made from a single interview. Most previous studies have investigated reliability. Comparison of recall of key symptoms and longitudinal reports shows the accuracy of recall, not just reliability. METHOD: At age 25, 1003 members of the Christchurch Health and Development Study cohort were asked to recall key symptoms of depression (sadness, loss of interest) up to age 21. This recall was compared with longitudinal reports at ages 15, 16, 18 and 21 years. Diagnosis was by DSM-III-R and DSM-IV criteria. RESULTS: Only 4% of those without previous reports recalled key symptoms. Of those with a diagnosis of depression up to age 21, 44% recalled a key symptom. Measures of severity of an episode (number of symptoms, impairment, duration, suicidally) and chronicity (years with a diagnosis, years with suicidal ideation) all strongly predicted recall. Current key symptoms increased recall, even after taking account of severity and chronicity. Being female and receiving treatment also predicted recall, although odds ratios were reduced to 1.6-1.7 when all other predictors were included. Comparison of risk factors for key symptoms showed similar results from longitudinal reports and recall. Sexual abuse, neuroticism, lack of parental attachment, gender, physical abuse and maternal depression were major risk factors in both sets of analyses. CONCLUSIONS: Forgetting of prior episodes of depression was common. Severity, chronicity, current depression, gender and treatment predicted recall. Lifetime prevalence based on recall will be markedly underestimated but the identification of major risk factors may be relatively little impaired.

Adolescent↗

PubMed2004

Drinking patterns in mid-adolescence and psychosocial outcomes in late adolescence and early adulthood.

AIMS: To describe the pattern of drinking at age 16 and to relate this to outcomes at 16-21 years and 21-25 years across a number of psychosocial domains. DESIGN: A prospective birth cohort study with annual follow-up until age 16 then at 18, 21 and 25 years. SETTING: Christchurch, New Zealand. PARTICIPANTS: Of 1265 subjects, 953 were interviewed at age 16. MEASUREMENTS: Multiple measures of family background were collected from birth to 16 years. Alcohol consumption was measured in terms of frequency, usual or last quantity drunk and most drunk per occasion. Problems were also recorded. Questions about psychiatric symptoms enabled Diagnostic and Statistical Manual (DSM) criteria to be applied. Detailed reports on educational outcomes, employment, sexual behaviours and offending were collected. FINDINGS: Four latent classes were required to describe drinking at age 16, but these appeared to lie along a single dimension which strongly predicted outcomes at ages 16-21 and 21-25 across all domains (alcohol-related, substance dependence, mental health, education, sexual relationships and offending). After controlling for background and correlates only a small number of outcomes were still related consistently to drinking at age 16 over both periods: most alcohol-related outcomes, the number of sexual partners and the extent of violent offending. CONCLUSIONS: Drinking at age 16 is a clear indicator of future life-course over most domains in late adolescence and early adulthood. Many of these associations are due to other covariates. Outcomes specific to drinking at age 16 are alcohol outcomes, number of sexual partners and violence.

Adolescent↗

PubMed2004

Are differences between graduates and undergraduates in a medical course due to age or prior degree?

BACKGROUND: The number of medical programmes targeted at graduates is increasing and there are reports of beneficial outcomes. However, many new graduate medical schools have simultaneously changed their admission criteria and curricula. This study aimed to determine whether there were differences between graduates and undergraduates on the same medical course and to establish which differences might be due to having a prior degree, the course itself or age at entry to medical school. METHODS: A questionnaire-based survey was administered to all students in Years 2-5. It included the Study Process Questionnaire, the Achievement Motivation Profile and Likert scale questions on career. RESULTS: Questionnaires were completed by 587 students (response rate 80.3%), of whom 143 had a prior degree. Whilst having a prior degree was associated with many outcomes, for most this disappeared, and the overall predictive ability of the model improved when age was included. Age at entry to medical school brought certainty and motivation about career choice, a prior degree had some effect on approaches to studying and co-operativeness, while the course itself had effects on most outcomes, some of which were positive and some negative. CONCLUSION: Graduates bring a distinct quality to a course but many of these relate to a student's age. Older age at entry may be more important than having a prior degree.

Adolescent↗

PubMed2004

Bipolar-panic disorder comorbidity within bipolar disorder families: a study of siblings.

OBJECTIVES: Although anxiety disorders often co-occur with bipolar disorder in clinical settings, relatively few studies of bipolar disorder have looked specifically at panic comorbidity. This report examines lifetime panic comorbidity within a sample of families with a history of bipolar disorder. METHODS: One hundred and nine probands with bipolar disorder and their 226 siblings were interviewed as part of a family-genetic study. Logistic regression was used to model bipolar disorder as a predictor of comorbid panic in those with affective disorder, with age at interview and gender included as covariates. RESULTS: The percentage with panic attacks was low in those without affective disorder (3%) compared with those with unipolar depression (22%) or bipolar disorder (32%). Panic disorder was found only in those with affective disorder (6% for unipolar, 16% for bipolar). When bipolar disorder and unipolar disorder were compared, controlling for age and sex, having bipolar disorder was associated with panic disorder (OR = 3.0, 95% CI = 1.1, 7.8) and any panic symptoms (OR = 2.0, CI = 1.0,3.8) and more weakly with the combination of panic disorder and recurrent attacks (OR = 1.8, CI = 0.9, 3.5). CONCLUSIONS: The absence of panic disorder and the low prevalence of any panic symptoms in those without bipolar or unipolar disorder suggest that panic is associated primarily with affective disorder within families with a history of bipolar disorder. Furthermore, panic disorder and symptoms are more common in bipolar disorder than in unipolar disorder in these families.

Adult↗

PubMed2004

Long-term survival of arteriovenous fistulas in home hemodialysis patients.

BACKGROUND: We report the outcome of arteriovenous (AV) fistulas created and managed by a multidisciplinary team in patients on hemodialysis (HD) over 20 years. METHODS: We analyzed 432 AV fistulas in 301 home HD patients (12% diabetic; median age 47 years) followed for up to 161 months. Observed end points were spontaneous or surgical AV fistula closure, or construction of a new vascular anastomosis. Survival was analyzed for first and second AV fistulas and predictors of outcome for first AV fistulas. RESULTS: One vascular surgeon constructed 58% of AV fistulas. Three hundred sixty-seven AV fistulas were in the forearm, 64 at or above the elbow, and 1 in the thigh. Four hundred fourteen AV fistulas used in situ vessels, and 18 were autografts. Two hundred thirty-one anastomoses were side-to-side. Only five grafts were placed during this time. There were 131 second and subsequent AV fistulas in 76 patients, 79 (60%) of which required primary construction, and 52 used arterialized vessels from a previous AV fistula. The median time from formation to use for first and second AV fistula, respectively, was 2.39 (SE 0.35) and 3.2 (SE 1.9) months. Assisted survival from first use for first AV fistula was 90% at 1 year, 66% at 5 years, 84% at 1 year, and 72% at 2 years for second AV fistula. AV fistula survival from creation was superior for side-to-side anastomoses (P < 0.0001) and in men (P= 0.05). CONCLUSION: A multidisciplinary approach has been successful in providing durable AV fistulas for home HD for >95% of consecutive patients entering our program.

Adolescent↗

PubMed2003

Fetal renal pelvic dilatation--poor predictor of familial vesicoureteral reflux.

The sensitivity and positive predictive value (PPV) of fetal renal pelvic dilatation for detecting vesicoureteral reflux (VUR) can only be determined by performing voiding cystourethrography (VCUG) on all newborns in a study population. We sought to determine this for infants with a family history of reflux. From June 1989 to September 1996, 157 children (80 males) under 2 years with a family history of primary VUR in a first-degree relative had VCUG. VCUG results were compared with the fetal renal pelvic diameter on obstetric sonogram performed after 16 weeks gestation. Of the 157 infants, 33 (11 boys) had primary VUR. In those with a parent as the index case, the prevalence of reflux was 5% in boys and 35% in girls ( P=0.03). The largest renal pelvic diameter after 16 weeks was not discriminatory for VUR, but after 30 weeks gestation a 4 mm renal pelvis had a sensitivity of 33% and a PPV of 32%. The sensitivity was higher for grades 4 and 5 (75%) than for grades 1-3 reflux (17%), ( P=0.04). In conclusion, fetal renal pelvic diameter has a low sensitivity and poor predictive value for detecting VUR, but this improves a little after 30 weeks gestation.

Female↗

PubMed2003

Posttraumatic stress disorder: do electrical startle responses and thyroid function usefully supplement self-report? A study of Vietnam War veterans.

OBJECTIVE: To investigate the usefulness of electrical startle responses and thyroid function as supplements to self-report measures of posttraumatic stress disorder (PTSD). METHOD: Invitations were sent to all New Zealand Vietnam War veterans known to be living in North Canterbury; 50 responded and the 35 living in or near Christchurch were included. Self-report measures of PTSD (the Davidson Trauma Scale (DTS) and the Symptom Check List (SCL-90-R) ), an eye blink electrical startle response and thyroid function were measured. The DTS was re-administered one to two weeks later to assess short-term test-retest reliability. Six months later the DTS and the electrical startle response were measured again. RESULTS: The veterans reported a wide range of PTSD severity, with 15/35 reporting prior diagnosis of PTSD. The DTS showed high short-term test-retest reliability (r = 0.93) and a moderate correlation after 6 months (r = 0.73). It also showed sensitivity to change; in one to two weeks the scores increased by nearly half a standard deviation, possibly because of an imminent "homecoming" march. The DTS and a PTSD scale from the SCL-90-R were highly correlated (r = 0.89). The total triiodothyronine (T3) to free thyroxine (T4) ratio measure of thyroid function correlated poorly with self-report (r < or = 0.27). The electrical startle response also correlated poorly with self-report (r < or = 0.26), showed low internal consistency between left and right sides (r = 0.43), and correlated 0.39 over six months. It was disliked by the veterans and had increased slightly at 6 month follow-up, perhaps because of sensitization. CONCLUSIONS: The DTS was reliable and correlated highly with the SCL-90-R PTSD scale. Neither thyroid function nor eye blink electrical startle correlated with each other or with self-report, and reliability was not good for electrical startle. These two measures do not appear to add anything useful to the assessment of PTSD.

Aged↗

PubMed2002

Chlamydia trachomatis prevalence and sexual behaviour in Christchurch high school students.

AIMS: To estimate the prevalence of Chlamydia trachomatis among young people in Year 12 and Year 13 in Christchurch secondary schools. METHODS: A cross-sectional survey on sexual behaviour was carried out in conjunction with the collection of urine samples, which were tested for C. trachomatis. RESULTS: 1582 young people were invited to take part in the study. 72% of these students answered the questionnaire of whom 49% had experienced sexual intercourse. The mean age of the sample was 16.7 years. The prevalence of C. trachomatis among the sexually active participants who provided a urine sample was 2.0% (1.8% of males and 2.3% of females). 39% of sexually active participants had had one partner in their lifetime and 13% had had more than five partners. 51% of males and 39% of females indicated that they always used condoms and 69% of males and 57% of females reported using a condom on the last occasion of sexual intercourse. CONCLUSIONS: Our study shows that 2.0% of sexually active senior high school students have asymptomatic C. trachomatis infections. Opportunistic screening for C. trachomatis should be offered to all sexually active males and females at risk.

Adolescent↗

PubMed2002

Effect of a rapid assessment clinic on the waiting time to be seen by a doctor and the time spent in the department, for patients presenting to an urban emergency department: a controlled prospective trial.

AIMS: To test the hypothesis that triaging certain emergency department (ED) patients through a rapid assessment clinic (RAC) improves the waiting times, and times in the department, for all patients presenting to the emergency department. METHODS: For ten weeks an additional nurse and doctor were rostered. On the odd weeks, these two staff ran a RAC and on even weeks, they did not, but simply joined the other medical and nursing staff, managing patients in the traditional way. Patients suitable for triage to the RAC were those for whom disposal was readily apparent, interventions required were quickly undertaken, and lengthy investigations or assessment were not required. After the ten-week period data from the five weeks of the RAC and the five weeks with no RAC, but the same staffing level, were analysed and compared. RESULTS: During the five weeks of the RAC clinic a total of 2263 patients attended the ED, and 361 of these were referred to the RAC clinic. During the five control weeks a total of 2204 patients attended the ED. There was no significant difference in the distribution across triage categories between the RAC and non-RAC periods. The waiting times to be seen by a doctor show no difference at Triage 2 and 3 and a difference of several minutes for Triage 4 and 5 categories. The times patients spent in the ED also show no difference for Triage 2 and 3 and about 20 to 25 minutes advantage for RAC-week patients in Triage categories 4 and 5. CONCLUSIONS: The rapid management of patients with problems which do not require prolonged assessment or decision making, is beneficial not only to those patients, but also to other patients sharing the same, limited resources.

Adolescent↗

PubMed2002

Hypertension as a determinant of survival for patients treated with home dialysis.

BACKGROUND: Previous studies of the risks of hypertension for dialysis patients have yielded conflicting results. The aim of this study was to investigate, in a home dialysis population with low rates of diabetes and antihypertensive drug use, whether blood pressure (BP) was an independent risk factor for survival. METHODS: The outcome of 168 consecutive patients (94 male, 88% Caucasian), aged 48 years (SD 16), who began home hemodialysis (HD; N = 124) or home continuous ambulatory peritoneal dialysis (CAPD; N = 44) between January 1, 1985 and December 31, 1994 were analyzed retrospectively. Only 4.7% of patients took antihypertensive drugs while on dialysis. The patients were followed to December 31, 1998 with the primary outcome being all-cause mortality. Censoring events were transplantation, transfer to another center and treatment modality change. The Cox proportional hazard model was used with baseline predictors. RESULTS: Seventy-one patients died and the median overall survival was 4.2 years (5.6 on HD, 2.2 on CAPD, P < 0.0001). Mean BP at start of dialysis predicted survival on its own (P = 0.0009) and in the joint Cox model (P = 0.047). Other significant predictors in the joint model were age [10 year increase, relative hazard (RH) = 1.55, P = 0.0008], albumin (10 g/L decrease, RH = 2.05, P = 0.007), diabetes (RH = 3.42, P = 0.015) and peripheral vascular disease (RH = 2.19, P = 0.02) but not dialysis modality (RH = 1.63, P = 0.13). High and low mean blood pressure (BP) values at the start of dialysis were associated with the highest mortality. CONCLUSIONS: Among the home dialysis patients, most of whom did not require antihypertensive drugs, hypertension was a risk factor for survival and patients with mid-range BP values survived the longest.

Adolescent↗

PubMedDate not supplied

Affective disorders in the first-degree relatives of bipolar probands: results from the South Island Bipolar Study.

The current study was performed to document observed rates of affective disorders in the first degree relatives of probands with bipolar I or II disorder; to determine whether bipolar II probands have an excess of bipolar II relatives; and to determine whether bipolar probands with a history of one or more suicide attempts have more relatives who have also made suicide attempts. Bipolar probands with positive family histories of affective disorder were recruited from a variety of sources for a study on the molecular genetics of bipolar disorder. Probands and relatives were interviewed with the Diagnostic Interview for Genetic Studies (DIGS) and blood was obtained for DNA extraction and genetic analyses. Among 423 first-degree adult relatives of 153 bipolar probands, 7% (29) had bipolar I disorder, 7% had bipolar II disorder, and 7% had bipolar not otherwise specified (NOS) disorder, making 21% of relatives with any bipolar disorder. A further 42% of relatives had a depressive disorder and only 38% had no affective disorder. A suicide attempt by a proband was not associated with any increase in suicide attempts by relatives. We conclude that while unipolar depressive disorders are the most common affective disorders in the first-degree relatives of bipolar probands, extension of the bipolar phenotype to include bipolar spectrum disorders results in 21% of relatives having any bipolar disorder.

Adult↗