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Biomedical subjects

J R Geddes

Publications and source records attributed to J R Geddes.

33 records · Page 2Linked to original sources
PubMed1996

The chief scientist reports.... Prevalence of psychiatric disorder, cognitive impairment and functional disability among homeless people resident in hostels.

This cross-sectional survey was performed to estimate the prevalence of psychiatric disorder among homeless residents of hostels in Edinburgh and to relate it to functional impairment. Full diagnostic assessments were completed on 136/198 (69%) of the subjects. Thirty-one per cent of subjects (95% CI 25, 42) had significant functional impairment and this was most strongly associated with the presence of functional psychosis and cognitive impairment. Few of the cognitively impaired subjects were in contact with health or social services.

Adult↗
PubMed1995

Period trends in rate of suicide in first 28 days after discharge from psychiatric hospital in Scotland, 1968-92.

OBJECTIVE: To examine period trends in the rate of suicide in the first 28 days after discharge from psychiatric hospital. DESIGN: Cohort study of patients discharged from psychiatric hospital. SETTING: Scotland. SUBJECTS: All patients aged 15-84 who were discharged from Scottish psychiatric hospitals during 1968 to 1992. OUTCOME MEASURE: The rate of suicide (classified as codes E950-9 and E980-9 according to the International Classification of Diseases, Ninth Revision) within 28 days of discharge per 100,000 person years at risk for five year periods during 1968 to 1992. Crude, within cohort rates and externally standardised rates were calculated. RESULTS: Overall, 196 male patients committed suicide in 20,520 person years at risk, and 171 female patients committed suicide in 24,114 person years at risk. A significant linear trend was seen in period effect on externally standardised mortality ratios in both sexes: a decrease in male patients (P = 0.008) and an increase in female patients (P = 0.0001). The adjusted standardised mortality ratio in 1988-92 compared with 1968-72 was 0.62 (95% confidence interval 0.39 to 0.98) in male patients and 2.73 (1.64 to 4.56) in female patients. CONCLUSION: The increase in the rate of suicide in the 28 days after discharge in female psychiatric patients makes this an increasingly important period to target. The rise has occurred against the background of a reduction of 60% in the number of psychiatric beds for adults.

Adolescent↗
PubMed1995

Schizophrenic subjects with no history of admission to hospital.

It has often been assumed that all subjects with schizophrenia will eventually be admitted to hospital and therefore little bias is introduced by restricting research to hospitalized subjects. Using the Lothian Psychiatric Case Register, 66 subjects were identified who had been diagnosed in Edinburgh as suffering from schizophrenia between 1978 and 1989 but had no history of hospital admission by December 1991. This represented an adjusted average of 6.7% of the estimated annual rate of first diagnosis of schizophrenia: the proportion of such patients did not change over the period. Using a case-control design, the index cases were compared with a control group of schizophrenic patients who had been admitted to hospital within 3 months of diagnosis. At the time of diagnosis, the cases were generally less disturbed with lower levels of violent behaviour and less evidence of neglect or hallucinations. They had a longer duration of illness prior to diagnosis, were more often diagnosed by a consultant and unemployed. In a follow-up study of the index cases, 59 (89%) were traced, of whom 6 (10%) were deceased. The outcome of the illness was heterogeneous although the course was often chronic. The general practitioner provided most of the care they received. The small proportion of such patients suggests that their exclusion from most published series does not seriously bias our picture of the natural history of schizophrenia. Moreover, as there was no increase in the proportion over the period, first admission rates for schizophrenia in Scotland are a reasonable approximation to incidence rates.

Activities of Daily Living↗
PubMed1995

Gender-specific changes since 1900 in the season-of-birth effect in schizophrenia.

BACKGROUND: It was hypothesised that the size of the season-of-birth effect may have decreased in tandem with the apparent decline in the incidence of schizophrenia. METHOD: Through the Aberdeen Psychiatric Case Register, subjects were identified who had been diagnosed as schizophrenic and had been born between 1900 and 1969. The ratio of winter/spring to summer/autumn births was compared across the seven decades for both sexes together, for men, and for women. RESULTS: For the 1935 men, but not for the 1620 women, there was a highly significant increase (P = 0.0009) in season-of-birth effect. CONCLUSION: Non-seasonal factors have contributed to a declining incidence of schizophrenia in both sexes. 'Seasonal' factors to which female foetuses are more susceptible than male foetuses (such as infection or malnutrition) have also decreased in frequency, severity, or both, but this has not happened with factors affecting males, leading to an increase of their season-of-birth effect.

Age Factors↗
PubMed1995

Obstetric complications and schizophrenia: a meta-analysis.

BACKGROUND: This systematic review of the association between schizophrenia and obstetric complications (OCs) was performed to assess the degree of heterogeneity between studies and to quantify the increased risk of schizophrenia in exposed subjects. METHOD: Twenty case-control, one prospective cohort and two historical cohort studies were identified using a MEDLINE search supplemented by a manual search and direct communication with other researchers. Individual odds ratios were calculated for each study and a pooled estimate produced. The effect of methodological variation between studies was further assessed by partitioning studies according to study characteristics. RESULTS: Overall, there was no significant heterogeneity of effect between studies, and the pooled odds ratio for the exposure to OCs on subsequent development of schizophrenia was 2.0 (95% CI 1.6-2.4). However, partitioning according to study design revealed significant heterogeneity (z = -2.60, P < 0.01) between the pooled estimate from the case-control studies and that from the historical cohort studies. There was a gap on the funnel plot in the region of small studies finding no effect. CONCLUSIONS: Although the result indicates that subjects exposed to OCs are twice as likely to develop schizophrenia, the analysis suggests that the observed association could be inflated by both selection and publication biases.

Case-Control Studies↗
PubMed1994

Mental health problems of the Edinburgh 'roofless'.

BACKGROUND: The roofless have not been previously surveyed in detail looking specifically at their psychiatric status. METHOD: All roofless people in a discrete area were interviewed in their 'skippers' using a semi-structured interview. Other roofless people helped in case finding and diagnostic validity was confirmed using a computerised case register. RESULTS: Sixty-five people were interviewed. High rates of substance abuse (n = 48, 75%), and very low rates of psychotic illness (n = 2, 3%) were found. High rates of serious physical morbidity, of imprisonment and of being the victim of a crime were found. CONCLUSION: The roofless have multiple severe medical, social, and psychiatric problems. These all must be addressed when considering the provision of services.

Adolescent↗
PubMed1993

Persistence of the decline in the diagnosis of schizophrenia among first admissions to Scottish hospitals from 1969 to 1988.

Age-standardised rates were calculated for first admissions to hospital in Scotland with ICD-9 diagnoses of schizophrenia, affective psychoses, paranoid psychoses, reactive psychoses and depressive neuroses (ICD-9 295, 296, 297, 298 and 300.4) for the period 1969-88. First-admission rates for schizophrenia declined by an average of 3.3% per year in males and 4.4% per year in females over the period. The first-admission rate in males in 1988 was 8.4/100,000 (57% of 1969 rate) and in females was 4.8/100,000 (43% of 1969 rate). Rates for depressive neuroses, affective psychoses, reactive psychoses and combined psychoses also fell. Rates for mania rose, as did those for paranoid states in males. The decrease in first-admission rates is likely to reflect a true decrease in the incidence of schizophrenia over the period. The decline was unlikely to be accounted for by diagnostic change because there was no reciprocal increase in any other diagnosis sufficient to account for the change, and the rates for combined psychoses also decreased. There was evidence that rates for schizophrenia declined to a greater extent in younger age groups, especially in females. This could imply the presence of a birth cohort effect.

Adolescent↗
PubMed1986

Factors influencing post-operative hospital stay after transurethral resection of the prostate gland.

The influence of 12 clinical and social factors on the length of post-operative stay in hospital after transurethral resection of the prostate was investigated in 100 patients. Using a multiple binary regression analysis, the factors significantly associated with a post-operative stay exceeding 6 days were: patient's age greater than 70 years (P less than 0.005), the presence of existing cardiovascular disease (P less than 0.005) and the weight of the prostate gland resected greater than 10 g (P less than 0.005). The first two factors are useful in providing a prediction of prolonged post-operative stay. The results indicate that those factors associated with a prolonged post-operative stay are beyond the control of the clinician.

Age Factors↗
PubMed1983

Mucinous and squamous metaplasia of the renal pelvis.

Mucinous and squamous cell metaplasia of the transitional cell epithelium occurs in response to chronic irritation and is predominantly found in the bladder. When the 2 forms of metaplasia occur simultaneously they usually are associated with malignancy. We report 2 cases of mucinous and squamous metaplasia of the epithelium of the renal pelvis that were not associated with malignancy. This is believed to be the fourth report of this divergent metaplasia. The mechanism for these changes is discussed.

Adult↗
PubMed1983

The treatment of large bladder diverticula.

Thirty-eight cases of large bladder diverticula treated surgically between 1970 and 1979 were reviewed. Twenty-two underwent diverticulectomy alone and 19 of these had no further trouble during a follow-up period averaging 4.5 years. Three other patients who had undergone resection of a small prostate gland prior to diverticulectomy might also have been cured by diverticulectomy alone. In at least half of the patients presenting with large bladder diverticula no obstructive factor was present and it is concluded that primary diverticula are more common than was previously thought. Clinically, primary diverticula may be distinguished from secondary on the basis of symptoms, cystoscopic findings of trabeculation and urodynamic studies. A more extensive application of the transperitoneal approach in performing diverticulectomy is recommended.

Adolescent↗
PubMed1982

Late presentation of ectopic ureter.

Primary urinary incontinence is a recognised symptom of ectopic ureter but it is unusual for incontinence in this condition to occur for the first time in adult life. Three cases are described of ectopic ureter presenting in adult life with incontinence; 2 were secondary to ectopic ureterovaginal fistula resulting from gynaecological procedures and one followed prolonged labour.

Adult↗