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Biomedical subjects

J M Court

Publications and source records attributed to J M Court.

At least 19 recordsLinked to original sources
PubMed1998

Cannabis and brain function.

Current literature and practice experience has been reviewed to clarify what is known about the effects of cannabis on brain function, the risk that cannabis use may pose for young people during their adolescence, and risk factors within the individual or their environment that may predispose to long-term abuse and dependence. There is sound evidence that cannabis intoxication has an adverse effect on cognitive function and behaviour, and may, in vulnerable individuals, lead to a psychotic reaction. Regular use may have an adverse effect on learning, with possible mid- to long-term psychological and cognitive impairment. Heavy use may lead to emotional dependence with consequent social and psychological dysfunction. Intervention strategies must go beyond the conventional education and public health measures that appear to have been unsuccessful so far in influencing cannabis use in teenagers. Such strategies may more usefully aim at assessment of risk factors in individuals and groups for dependence on the drug, and the combined and cooperative intervention of parents, schools, health professionals and teenagers themselves.

Adolescent↗
PubMed1998

Impaired doctors. The modern approach of medical boards.

BACKGROUND: Australian medical boards now emphasize treatment and rehabilitation, where possible, for doctors who are ill or drug dependent and hence impaired. OBJECTIVE: This article describes the processes and experience of the Medical Practitioners Board of Victoria following the introduction of the Medical Practice Act 1994. DISCUSSION: Impaired practitioner programs usually encompass: assessment by an independent relevant specialist negotiation of appropriate conditions on practice to ensure both community protection and support for the doctor during treatment and rehabilitation medical supervision, regular urine testing and appropriate conditions on practice for drug dependent doctors. Difficult issues can arise in relation to ageing doctors, psychotic doctors lacking in insight and drug dependency with extreme denial. While results of rehabilitation are encouraging, the profession needs to do even more in regard to prevention, early detection and provision of high speciality treatment and rehabilitation.

Australia↗
PubMed1993

Issues of transition to adult care.

A survey was carried out on adolescents with insulin dependent diabetes mellitus, aged 15 to 18 years, to elicit their views on the process of transfer from paediatric to adult care. The survey provided information on what they expected from a health service during this period of their life, their views on the role of specialist physicians and other health professionals and their preferred age for transfer from a paediatric to an adult service. Young people value continuity of care by a physician whom they trust. They expect confidentiality and privacy, some degree of informality and optimal waiting room conditions when they attend for consultation. Almost all suggested that transfer of care should be after the age of 17 years. An understanding of the views and expectations of young people with a chronic illness such as diabetes should assist those who are responsible for the development of health care. It is recommended that transition services for young people with a chronic illness be developed at those children's and adult hospitals that provide specialist care for them.

Adolescent↗
PubMed1991

Factors predicting residual beta-cell function in the first year after diagnosis of childhood type 1 diabetes.

Twenty-five children aged 2-14 years (mean age 8.39 +/- 0.78 years) were studied prospectively during the first year after the diagnosis of type 1 diabetes. Of their clinical and metabolic features at diagnosis, only age showed a significant independent relationship with endogenous C-peptide production during the first year. Age was correlated with higher values for basal and stimulated plasma C-peptide at 7-14 days after diagnosis, at 6 months and at 12 months. At diagnosis, age was also associated with a higher value for HbA1c and a lower prevalence of insulin antibodies. C-peptide production peaked at 3 months and thereafter declined. Mean HbA1c and insulin requirement were both minimal at 6 months. At diagnosis, there were significant inverse relationships between basal C-peptide production and both insulin dose and HbA1c and between stimulated C-peptide production and HbA1c. Basal and stimulated C-peptide production were inversely related to insulin dose at 6 and 12 months. Stimulated C-peptide was higher at 12 months in children retaining islet cell antibodies. These findings confirm the importance of age as a predictor of residual beta-cell function in type 1 diabetes and indicate that older children present clinically following a slower course of beta cell destruction.

Adolescent↗
PubMed1991

Outpatient-based transition services for youth.

There is a paucity of information on the process of transition from pediatric to adult services for young people with chronic disease/disability. Adolescents and young adults have differing needs from children and older adults, and ideally transition services should take these needs into account. Diabetes provides a useful model to examine the process of transition and to seek views of young people. A study of 70 young adults with diabetes is reported. It is suggested that the ideal time for a transfer from a pediatric to an adult service is between 17 and 20 years, but this will vary considerably depending on developmental needs. Specialist physicians remain the most important professionals in the view of the young diabetics, who valued the physician as one to whom they can relate and get to know well by seeing regularly. The role of educational programs and help with psychosocial problems at this age are discussed in the light of conflicting evidence in the literature.

Adolescent↗
PubMed1989

Double-blind controlled trial of azathioprine in children with newly diagnosed type I diabetes.

A double-blind controlled trial of azathioprine (2 mg.kg-1.day-1) was conducted with 49 patients aged 2-20 yr (mean 10.8 yr) who had newly diagnosed type I (insulin-dependent) diabetes. Patients were randomly assigned to receive either azathioprine (n = 24) or placebo (n = 25) for 12 mo, beginning within the 20-day period after diagnosis. Baseline clinical and metabolic characteristics did not differ between the two groups. No patient experienced complete remission, defined as restoration of normal carbohydrate tolerance without other treatment. Partial remission, defined as good metabolic control (hemoglobin A1c less than or equal to 7.9%, preprandial blood glucose less than or equal to 8 mM with an insulin dose of less than 0.5 U.kg-1.day-1), occurred in 10 placebo (40%) and 7 azathioprine (29%) patients at 6 mo and in 4 placebo (16%) and 4 azathioprine (17%) patients at 12 mo (differences not significant). Fasting plasma C-peptide was significantly greater in the azathioprine-treated group at 3 and 6 mo, but this difference was not sustained. C-peptide responses to a standard meal and the frequency of islet cell and insulin antibodies did not differ between the two groups over the 12-mo period. Azathioprine caused no significant side effects. We conclude that in the dosage used, and despite early effects on endogenous insulin secretion, azathioprine alone does not influence the remission phase in children with newly diagnosed type I diabetes.

Azathioprine↗
PubMed1989

Health literature for parents of children with cerebral palsy.

This study examined the use of and need for written educational material by the parents of 41 children with cerebral palsy, aged between five and 63 months. After their initial counselling, the majority felt that they needed written information. The parents of 31 children attempted to find suitable books or pamphlets, but in 13 cases they failed to do so or found the material unsatisfactory. A significant association was found between reading material which the parents found satisfactory and their knowledge about the basic features of cerebral palsy.

Books↗
PubMed1987

Objective assessment of limb movement in children with cerebral palsy.

A preliminary report of a method for assessing the quality of movement in children with cerebral palsy, using an accelerometer, is presented. Able-bodied and disabled children performed a simple task, and there were marked differences between the two groups. Whilst the technique requires further development, it is hoped that accelerometry may eventually provide an objective tool to enable rigorous testing of various therapeutic procedures in cerebral palsy.

Acceleration↗
PubMed1984

Diabetic vasculopathy in the rat: an in vivo microscopic study of the circulation.

A transparent tissue chamber adapted to the rat back was used for in vivo observation of vascular and circulatory changes in the streptozotocin diabetic rat. The chamber was implanted in a functional and richly vascularized bed of striated muscle. Extensive red cell rouleaux formation was observed within 2-7 days of induction of hyperglycaemia and was closely followed by development of constrictions and dilatations in both venules and arterioles. In 3 of 7 diabetic rats saccular microaneurysms, similar in form to those reported in diabetic animals and humans, developed in the vascular bed. The rat back chamber provides an opportunity for continuous in vivo study of vascular lesions developing in streptozotocin diabetes. Fixation under microscopic observation allows close correlation of functional changes in vivo with the ultrastructural appearance of specific tissue areas.

Animals↗
PubMed1984

Vitreous fluorophotometry in children with type I diabetes mellitus.

A clinical, biochemical and ocular study was carried out on 17 children with type I diabetes mellitus. Eight had no clinical or angiographic evidence of retinopathy (Stage 0), seven had stage 1, one had stage 2 background retinopathy (Malone's classification) and one had intraretinal microvascular abnormalities. The vitreous fluorescein concentration 3 to 5 mm in front of the macula in those without retinopathy varied from low to abnormally high, while the concentrations in those with retinopathy were above normal. There was no correlation between haemoglobin A1 estimations taken at the time of the study and the vitreous fluorophotometry readings. This variation in fluorophotometry values obtained in diabetics with stage 0 disease differs from the findings in previous reports and may be of prognostic value in determining those patients at risk of developing retinopathy, and may be an indication for improving diabetic control.

Adolescent↗
PubMed1983

Erythrocyte membrane fluidity in type 1 diabetes mellitus.

Erythrocyte membrane fluidity was determined in a group of type 1 diabetics in varying metabolic control. No difference in membrane fluidity, as measured by fluorescence polarization of 1,6-diphenyl-1,3,5-hexatriene, was found between cells from diabetic subjects. In addition, no difference was detected in membrane phospholipid and cholesterol content or the ratio of cholesterol to phospholipid in the diabetic subjects when compared to controls. The present study suggests that changes in erythrocyte membrane fluidity do not play a major role in the alterations of the physical properties of blood seen in type 1 diabetes mellitus.

Adolescent↗