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Biomedical subjects

J M Rey

Publications and source records attributed to J M Rey.

At least 37 records · Page 2Linked to original sources
PubMed2000

Cathepsin D in breast cancer: mechanisms and clinical applications, a 1999 overview.

A short review of the literature first confirms the clinical value of cathepsin D as a prognostic marker in breast cancer, when using well standardized assays. We then summarize results of studies, mostly performed in our laboratory, aimed at understanding the effect of cathepsin D overexpression on metastasis and the molecular mechanisms involved. Cathepsin D-cDNA transfection increases tumor cell proliferation in vitro and the metastatic potential of 3Y1-Ad12 embryonic rat tumorigenic cells when injected in vivo into nude mice. The mechanism by which cathepsin D increases the incidence of clinical metastasis involves increased cell growth and decreased contact inhibition rather than escape of cancer cells through the basement membrane. Different mechanisms are considered to explain this mitogenic activity. Cathepsin D could act as a protease following its activation at an acidic pH, or as a ligand of different membrane receptors at a more neutral pH. In this case cathepsin D can displace IGFII from the mannose-6-phosphate/IGFII receptor to the IGFI receptor or activate another membrane receptor to be identified. The nature of the mechanisms involved in vivo may depend on the micro environment of the tumor cells. These studies should guide in the development of new therapies aimed at inhibiting the deleterious effect of overexpressed cathepsin D.

Animals↗
PubMed2000

Patterns of use, attitudes and expectations of mental health staff regarding computers.

There is limited information on the views of mental health staff about computers. The present study aimed to ascertain the patterns of use, attitudes and expectations of staff from a comprehensive mental health service regarding computers before and after the purchase of new equipment and training. A questionnaire was sent to staff of the Central Sydney Mental Health Services working in sites targeted for new computer equipment and training. Most respondents, especially those with computer experience or who had worked in mental health for less than 5 years, viewed computers favourably. At the same time, half the respondents did not feel they had sufficient access to a computer at work and the vast majority had not received training as intended. Commitments to provide computer equipment and training must be followed through, otherwise staff may feel disenchanted and computers may be regarded less favourably. A measure of the positive views about computer use ('positivity index') developed during the course of the current study may have wider applicability.

Adult↗
PubMed2000

Psychiatrists' experience and views regarding St John's Wort and 'alternative' treatments.

OBJECTIVE: This study aims to ascertain the experience and views of psychiatrists in relation to St John's Wort and alternative treatments generally. METHOD: A questionnaire was posted to all members of the Royal Australian and New Zealand College of Psychiatrists living in Australia or New Zealand. RESULTS: Of the 1910 mailed questionnaires, 862 (45%) were returned. Eighty per cent of respondents had patients who had used the herb. Side-effects and drug interactions were reported by 28% and 8% respectively of these psychiatrists. Some adverse events were described as serious. Psychiatrist attitudes about St John's Wort and alternative treatments were positive overall and psychiatrists seemed willing to recommend St John's Wort despite limited evidence of its usefulness. CONCLUSIONS: Psychiatrists in Australia and New Zealand regularly manage patients who take St John's Wort and a considerable number actually recommend the treatment. However, they also report side-effects and drug interactions. Psychiatrists should routinely enquire about their patients' use of alternative treatments, be mindful of possible side-effects and in particular be aware of the dangers of combining St John's Wort with other psychotropics.

Adult↗
PubMed2000

Family environment in attention deficit hyperactivity, oppositional defiant and conduct disorders.

OBJECTIVE: This study aims to ascertain whether there were differences in family environment among patients with attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder and conduct disorder. METHOD: The records of 233 patients, selected for high or low scores on a scale that taps ADHD symptoms, were reviewed by three clinicians who made DSM-IV diagnoses and rated the family environment with the Global Family Environment Scale (GFES). Self-report data obtained from the parent and child versions of the Child Behaviour Checklist were also used. The quality of the family environment was then compared between the various diagnostic groups. RESULTS: A poorer family environment was associated with conduct disorder and oppositional defiant disorder and predicted a worse outcome (e.g. admission to a non-psychiatric institution, drug and alcohol abuse). Quality of the family environment did not vary according to ADHD diagnosis or gender. CONCLUSIONS: There seems to be no association between the quality of the family environment and a diagnosis of ADHD among referred adolescents. However, there is an association with conduct disorder. Interventions that improve family environment in the early years of life may prevent the development of conduct problems.

Adolescent↗
PubMed2000

Rating the quality of the family environment in different cultures.

OBJECTIVE: To examine the extent to which clinicians from different cultures agree when rating the quality of a child's family environment and the effect of country, language, and training factors on these ratings. METHOD: Eighty-seven health professionals from Malaysia, Spain, Australia, Indonesia, the United States, Denmark, and Singapore rated 7 case vignettes using the Global Family Environment Scale. Half (54%) were psychiatrists. One quarter (26%) performed the ratings after attending a training session, the rest (n = 64, 74%) after reading a training manual. RESULTS: Overall, interrater agreement (intraclass r) was 0.84 (95% confidence interval: 0.68-0.96). There were no significant differences in agreement according to country, language, training, or professional group, although there were country differences in the ratings given to 2 vignettes. The majority of raters found the description of the anchor points (86%), training manual (95%), and case vignettes (97%) clear. CONCLUSIONS: Clinicians from different cultures seem to be able to make global ratings of the quality of the family environment that are reliable and consistent when using case vignettes. This can be achieved with little training. Global ratings of the quality of the family environment may be a useful tool in mental health research and clinical work.

Adult↗
PubMed2000

Semiquantitative reverse transcription-polymerase chain reaction to evaluate the expression patterns of genes involved in the oestrogen pathway.

The increasing number of factors to be taken into account in the oestrogen transcriptional process has created a need to develop a rapid screening method to evaluate their role in physiology and pathology. Molecular biology techniques enable gene expression studies at the mRNA level with small amounts of tissues. We therefore developed a semi-quantitative reverse transcription-polymerase chain reaction (RT-PCR) technique using fluorescent oligonucleotides to analyse simultaneously a large panel of interrelated genes involved in the oestrogen transcriptional pathway using a moderately expressed housekeeping gene, the hypoxanthine phosphoribosyltransferase gene (HPRT), as the reference gene. Expression levels of oestrogen receptors (ERalpha, ERbeta), cofactors AIB1, RIP140, SMRT and the Fas-associated protein-tyrosine phophatase-1 (FAP-1) genes were evaluated in breast, endometrial and ovarian cancer cell lines and in three ERalpha-positive and three ERalpha-negative breast cancer tumours. This technique provides a rapid and reliable way to quantitate simultaneously numerous mRNAs of genes involved in the oestrogen pathway from small amounts of tissues.

Adaptor Proteins, Signal Transducing↗
PubMed1999

Parental satisfaction and outcome: a 4-year study in a child and adolescent mental health service.

OBJECTIVE: The aim of this paper is to examine the facets of parental satisfaction and its relationship with clinician-rated outcome in a child and adolescent mental health service. METHOD: Patients (n = 1278) consecutively assessed between 1992 and 1996 were included in the study. When treatment ended, clinicians rated the outcome of the intervention and parents were asked to complete a satisfaction questionnaire. RESULTS: Sixty-nine per cent of cases were rated by clinicians as having a positive outcome. Outpatients were more likely to be given a positive rating than inpatients. Satisfaction questionnaires were returned by 40% of parents; 76% of these were mostly or very satisfied. Satisfaction scores increased with the number of outpatient sessions attended but did not differ between inpatients and outpatients. There was a significant but small agreement (27% better than chance) between clinicians' rating of outcome and parental satisfaction. Level of agreement varied according to service provided and the number of sessions attended. While rates of positive outcome increased over the study period, ratings of satisfaction were stable. CONCLUSIONS: Overall, ratings of satisfaction were comparable with those reported in other studies. Variations in concordance between parents and clinicians show that outcome and satisfaction, although related, are different constructs influenced by different factors depending on the services provided. Focusing on specific aspects of satisfaction, as opposed to global measures, may be more useful for services, although such undertakings must be supported with efforts to improve clinical outcomes.

Adolescent↗
PubMed1999

Experience, knowledge and attitudes of mental health staff regarding patients' problematic drug and alcohol use.

OBJECTIVE: The aim of this study was to assess the experience, knowledge and attitudes of mental health staff regarding patients' problematic drug and alcohol use in order to provide direction for planned drug and alcohol education. METHOD: A 47-item questionnaire was developed and individually posted to all mental health staff employed by Central Sydney Area Health Service (n = 536). RESULTS: Three hundred and thirty-eight (63%) staff members completed the questionnaire. Thirty-six percent of respondents had received drug and alcohol training and 41% had drug and alcohol work experience. Drug and alcohol training and work experience were associated with increased drug and alcohol knowledge. Respondents' perception of their knowledge and competence was positively correlated with their actual knowledge. Most staff reported having regular contact with patients with psychotic illnesses and drug and alcohol problems. The majority considered the management of this patient group difficult and currently inadequate. Seventy percent believed that as mental health professionals they had a role to play in the management of their patients' drug and alcohol problems. Almost all (95%) were willing to participate in further education and training in this area. CONCLUSIONS: Mental health staff are often confronted with drug and alcohol problems in patients with psychotic illnesses. They perceive a need for drug and alcohol education and training specific to the management of these patients. Future research will need to evaluate outcomes of education and training programs for both staff and patients.

Adult↗
PubMed1999

The relevance of herbal treatments for psychiatric practice.

OBJECTIVE: The aim of this paper is to inform psychiatrists about the basic principles, terminology, schools of thought, efficacy, safety and regulatory issues regarding herbal treatments for mental illness. METHOD: Information was obtained by computerised and manual searching of medical and botanical data bases, and by discussions with experts in herbal medicine and regulatory aspects of the pharmaceutical industry. RESULTS: Herbal medicines are commonly used in developed and developing countries for psychiatric illness. The main schools of herbal medicine in Australia are Western herbal medicine, traditional Chinese medicine and 'Ayurveda' (Indian herbal medicine). Herbs used for psychiatric or neurological disorders are termed 'nervines'. Three nervines which have attracted considerable attention recently are St John's Wort, Gingko biloba and Valeriana officinalis. In Australia, most herbal drugs are classed as 'listed drugs' which are required to satisfy less rigorous safety and efficacy criteria than 'registered drugs'. The popularity of herbal remedies has a number of clinical and research implications for psychiatry. CONCLUSIONS: Psychiatrists should not endorse treatments that are unsupported by sound research, nor remain ignorant about alternative approaches to mental illness. The extent of use of herbal treatments for mental illness suggests that psychiatrists should become more knowledgeable about developments in this area.

Adverse Drug Reaction Reporting Systems↗
PubMed1999

Use of St. John's Wort by adolescents with a psychiatric disorder.

Herbal remedies are commonly used for psychiatric problems, but there is virtually no data about the use of these substances by young persons or by patients in treatment. Four adolescents who used St. John's Wort while under psychiatric care are described. Three of the patients had been reluctant to reveal this to their psychiatrist, believing the doctor had no interest in alternative medicine or would disapprove. Patient beliefs that prescribed medication has limitations and that natural products are safe contributed to the use of herbal remedies. The cases raise a number of issues, including the need for clinicians to routinely ask patients about alternative medicine use, to learn more about these treatments, and to discuss these approaches objectively with patients.

Adolescent↗
PubMed1999

Electroconvulsive therapy in adolescents: experience, knowledge, and attitudes of recipients.

OBJECTIVE: To ascertain the experience, knowledge, and attitudes regarding electroconvulsive therapy (ECT) of persons who received the treatment in adolescence. METHOD: A 53-item survey was administered by telephone to persons who received ECT before the age of 19 years in the Australian state of New South Wales between 1990 and 1998. RESULTS: Twenty-six patients were interviewed. Experiences and opinions about ECT were generally positive. Fifty percent stated ECT had been helpful. Approximately three quarters believed their illness was worse than either ECT or pharmacotherapy. Frequencies of recalled side effects with ECT and medication were similar. Some patients perceived deficiencies in the consent process. A slight majority had attempted to conceal the history of ECT treatment. The vast majority considered ECT a legitimate treatment and, if medically indicated, would have ECT again and would recommend it to others. CONCLUSIONS: The findings are consistent with and complement evidence showing ECT to be an effective and safe treatment for seriously ill adolescents. The mostly favorable experiences and attitudes reported by interviewees will be reassuring to adolescent patients, their families, and treating health professionals when ECT is being considered.

Adolescent↗
PubMed1999

Views about treatment among parents of adolescents who received electroconvulsive therapy.

The study assessed the experience, knowledge, and attitudes of parents of adolescents who had been treated with electroconvulsive therapy (ECT) about that treatment. Twenty-eight parents were interviewed. Overall, their opinions about ECT were favorable. Seventeen of 28 parents thought that ECT had been helpful. If ECT was recommended by a doctor, the vast majority of parents would support a decision for their child to have the treatment again and would advise others to consider it.

Adolescent↗
PubMed1999

Practitioner review: electroconvulsive therapy in adolescents.

There is increasing interest regarding electroconvulsive therapy (ECT) in young persons but limited information about its optimal use. This paper reviews the indications, effectiveness, and side effects of the treatment in the teenage population and their implications for everyday clinical practice. There is particular reference to factors influencing the clinician to recommend or advise against convulsive therapy, steps in the assessment of patients, and consent issues. Practical aspects of ECT administration are also examined, including treatment locale, anaesthesia, electrode position, stimulus characteristics, EEG monitoring, and use of psychotropics during and after the ECT course.

Adolescent↗
PubMed1998

Differential expression of estrogen receptor-alpha and -beta messenger RNAs as a potential marker of ovarian carcinogenesis.

Although estrogen receptor (ER)-alpha is expressed in both benign and malignant ovarian tumors, the role of ER in ovarian carcinogenesis of epithelial tumors is still unknown. In view of the recent characterization of ER-beta, a second form of ER that seems to be highly expressed in ovaries, we reexamined this issue by studying the relative expression of ER-alpha and -beta in human ovarian tumor progression. We developed a competitive PCR assay based on coamplification of the two ERs in target nucleotide sequences displaying a high homology (exons 3 and 4). Coamplification experiments with varying amounts of plasmids containing ER-alpha and -beta cDNAs showed that this assay was reliable for discriminating as little as a 2-fold difference in the initial ER-alpha:ER-beta cDNA ratio. The relative expression of ER-alpha compared with ER-beta mRNAs was studied in human ovarian cancer cell lines (n = 5) and in normal ovaries (n = 6), then in human benign and malignant tumor samples including ovarian cysts (n = 24), borderline tumors (n = 3), and cancers (n = 10). In normal ovaries, ER-beta mRNA was the predominant ER form, whereas in ovarian cancer cell lines ER-alpha mRNA was markedly increased as compared with ER-beta. In benign and borderline tumors, ER-beta mRNA was detected in 78% of tumors, whereas ER-alpha mRNA was detected in 29%. In ovarian carcinomas, both ER-alpha and -beta mRNAs were expressed in 80% of tumors. The ER-alpha:ER-beta mRNA ratio was >1 in only one cyst sample (4%). In contrast, the ER-alpha:ER-beta mRNA ratio was markedly increased in ovarian cancers because 60% showed an ER-alpha:ER-beta mRNA >1. In situ hybridization experiments showed overlapping tissular distribution of ER-beta and -alpha expression in cancers and cysts, with a main localization in the epithelium and only a low level of expression in stromal cells. In summary, we found an increase in the ER-alpha:ER-beta mRNA ratio in ovarian carcinomas as compared with normal ovaries and cysts. These data suggest that overexpression of ER-alpha relative to ER-beta mRNA may be a marker of ovarian carcinogenesis.

Biomarkers, Tumor↗
PubMed1998

Three-year outcome of disruptive adolescents treated in a day program.

Adolescents (N = 38) who attended a multi modal day program were matched with a control group (N = 35) for age, gender, year of assessment, and on delinquent and aggressive scores. Parent and child were separately interviewed three years after initial assessment. Adolescents who attended the program functioned better overall and were more satisfied with treatment than controls. Both groups showed a poor outcome and a decrease in symptom scores. A diagnosis of conduct disorder, high delinquency scores and high total problem scores predicted a poorer outcome.

Adolescent↗
PubMed1998

Endoscopy of mandibular cysts after cystostomy: a preliminary report.

PURPOSE: This study evaluated the use of endoscopy to explore mandibular cysts after cystostomy. MATERIALS AND METHODS: Six mandibular cysts were explored with a fiber endoscope immediately after cystostomy, allowing evaluation of the appearance of the cyst lining and biopsies to be performed. RESULTS: The lining of the cyst wall had a pearly appearance. It was easy to visualize the interior of large cysts extending from the body into the ramus, as well as to explore lobes and recesses. In no case did biopsies of the cyst lining indicate a neoplasm. CONCLUSIONS: Fiber endoscopy is a useful technique for the exploration and monitoring of mandibular cysts after cystostomy, particularly in cases in which the cyst extends from the body into the ramus.

Biopsy↗