Search PubMed⌕ Search

Biomedical subjects

Jonathan Hill

Publications and source records attributed to Jonathan Hill.

At least 19 recordsLinked to original sources
PubMed2006

The role of child abuse and age in vulnerability to emotional problems after surgery for breast cancer.

Emotional problems are common after breast cancer, but patients differ in their vulnerability. Childhood abuse is a risk factor for emotional problems in adult women, and we tested whether it explains some of the variability in emotional problems after breast cancer. Women with primary breast cancer (N=355) 2-4 d after surgery (mastectomy or wide local excision) self-reported current emotional distress, post-traumatic stress, self-blame, bodily shame and recollections of childhood sexual, physical and emotional abuse. Multiple logistic regression analyses tested the relationship of each emotional problem to abuse, distinguishing three age-groups, divided at 50 and 65 years. Emotional distress, post-traumatic stress, self-blame and shame were present in 49%, 8%, 22% and 13% of women, respectively. Each problem was more common in women who recalled one or other form of abuse. Apart from emotional distress, emotional problems were less common in older women. Older women were also less likely to recall abuse, and recall of abuse contributed statistically to explaining the relationship of youth to emotional problems. Childhood abuse is a risk factor for emotional problems after surgical treatment for breast cancer, and the challenge of identifying and helping those patients in whom emotional problems reflect pre-morbid vulnerabilities needs careful consideration. Because both emotional problems and abuse are strongly age-linked, future research should avoid generalisations across the age spectrum.

Affective Symptoms↗
PubMed2006

The Knee Clinical Assessment Study-CAS(K). A prospective study of knee pain and knee osteoarthritis in the general population: baseline recruitment and retention at 18 months.

BACKGROUND: Selective non-participation at baseline (due to non-response and non-consent) and loss to follow-up are important concerns for longitudinal observational research. We investigated these matters in the context of baseline recruitment and retention at 18 months of participants for a prospective observational cohort study of knee pain and knee osteoarthritis in the general population. METHODS: Participants were recruited to the Knee Clinical Assessment Study-CAS(K)--by a multi-stage process involving response to two postal questionnaires, consent to further contact and medical record review (optional), and attendance at a research clinic. Follow-up at 18-months was by postal questionnaire. The characteristics of responders/consenters were described for each stage in the recruitment process to identify patterns of selective non-participation and loss to follow-up. The external validity of findings from the clinic attenders was tested by comparing the distribution of WOMAC scores and the association between physical function and obesity with the same parameters measured directly in the target population as whole. RESULTS: 3106 adults aged 50 years and over reporting knee pain in the previous 12 months were identified from the first baseline questionnaire. Of these, 819 consented to further contact, responded to the second questionnaire, and attended the research clinics. 776 were successfully followed up at 18 months. There was evidence of selective non-participation during recruitment (aged 80 years and over, lower socioeconomic group, currently in employment, experiencing anxiety or depression, brief episode of knee pain within the previous year). This did not cause significant bias in either the distribution of WOMAC scores or the association between physical function and obesity. CONCLUSION: Despite recruiting a minority of the target population to the research clinics and some evidence of selective non-participation, this appears not to have resulted in significant bias of cross-sectional estimates. The main effect of non-participation in the current cohort is likely to be a loss of precision in stratum-specific estimates e.g. in those aged 80 years and over. The subgroup of individuals who attended the research clinics and who make up the CAS(K) cohort can be used to accurately estimate parameters in the reference population as a whole. The potential for selection bias, however, remains an important consideration in each subsequent analysis.

Aged↗
PubMed2005

Effectiveness of manual therapy or pulsed shortwave diathermy in addition to advice and exercise for neck disorders: a pragmatic randomized controlled trial in physical therapy clinics.

OBJECTIVE: To determine whether manual therapy or pulsed shortwave diathermy, in addition to advice and exercise, provide better clinical outcome at 6 months than advice and exercise alone in primary care patients with nonspecific neck disorders. METHODS: This was a multicenter, 3-arm randomized controlled trial in 15 physical therapy departments. Of the 735 screened patients, 350 were recruited to the study (mean age 51 years) from July 2000 to June 2002. Participants were randomized to advice and exercise plus manual therapy, advice and exercise plus pulsed shortwave, or advice and exercise alone. Assessments were undertaken at baseline, 6 weeks, and 6 months. The primary outcome was the Northwick Park Neck Pain Questionnaire. Analysis was by intention to treat. RESULTS: Of the participants, 115 were allocated to advice and exercise, 114 to advice and exercise plus manual therapy, and 121 to advice and exercise plus pulsed shortwave; 98% received the allocated treatment. There was 93% followup at 6 months. The mean +/- SD fall in Northwick Park score at 6 months was 11.5 +/- 15.7 for advice and exercise alone, 10.2 +/- 14.1 for advice and exercise plus manual therapy, and 10.3 +/- 15.0 for advice and exercise plus pulsed shortwave. There were no statistically significant differences in mean changes between groups. CONCLUSION: The addition of pulsed shortwave or manual therapy to advice and exercise did not provide any additional benefits in the physical therapy treatment of neck disorders.

Adult↗
PubMed2005

Abiotic production of methylmercury by solar radiation.

Methylmercury [MeHg(I) in the aerobic surface water of lakes is thought to be rapidly degraded, but contrary to expectations, we show that MeHg(I) concentrations often increase during sunlight hours or remain relatively constant. We hypothesized that there were water column processes that generated MeHg(I) and that these processes were linked to dissolved organic matter (DOM) and solar radiation. A 2-day diurnal pattern of MeHg(I) in surface water with corresponding bottled controls was assessed for two contrasting lakes in Kejimikujik, Nova Scotia, Canada. Following this study, a tangential ultrafiltrator was used to size-fractionate and generate a concentration gradient of DOM from four different lakes located near Lac Berthelot, Quebec, Canada. The watersheds of two of these lakes were not substantially logged whereas the other two had been extensively logged. Different size fractions of DOM as well as different concentrations of DOM were exposed to sunlight for varying periods of time. We observed that, in Keiimikujik, the concentration of MeHg(I) in surface waters peaked in the early afternoon. Furthermore, this also occurred in bottled water for one of the lakes, Puzzle, eliminating the possibility that in-lake mixing played a role in this pattern. The formation of MeHg(I) was found to be dependent on the size fraction and amount of DOM present in the water. Specifically, DOM less than 5 kDa or between 30 and 300 kDa generated MeHg(I) when exposed to sunlight, but larger fractions did not. Furthermore, although data are limited, we found that water from lakes with logged watersheds generated MeHg(I) when exposed to sunlight, whereas water from lakes with low levels of logging in the undisturbed watersheds did not. Our results demonstrate that MeHg(I) can be formed in freshwaters of certain lakes in response to solar radiation. This photoproduction of MeHg(I) is dependent on DOM concentrations and type, with the importance of water chemistry not yet clear. The significance of this process to freshwater lakes and the mechanism responsible for MeHg(I) photoproduction is still unclear, but a correction in the conventional wisdom that MeHg(I) is rapidly photodegraded is timely.

Animals↗
PubMed2005

Perceived relationships with parents and paranoid delusions: comparisons of currently ill, remitted and normal participants.

BACKGROUND: Paranoid delusions are associated with abnormal attributions and abnormal beliefs about the self. Some researchers have also reported an association between paranoid beliefs and abnormal attachment representations. SAMPLING AND METHODS: Perceptions of relationships with the family of origin were measured in 14 currently ill paranoid patients, 9 remitted paranoid patients and 15 healthy controls, using two methods: the Parental Bonding Instrument (PBI), and the Relationship with Family of Origin Scale (REFAMOS), an interview-based assessment. RESULTS AND CONCLUSIONS: On the PBI, both currently ill and remitted patients reported low parental care and overprotectiveness during childhood. Similar negative accounts of relationships with parents during the 16-20 years age period, and also at the time of assessment, were elicited from both the ill and remitted patients on the REFAMOS. These findings might reflect the influence of illness on patients' perceptions of their parents. However, the fact that the remitted patients did not differ from the currently ill patients raises the possibility that dysfunctional relationships are a common feature of the history of paranoid patients, perhaps contributing to the development of paranoid thinking.

Adolescent↗
PubMed2005

Reproducibility and inter-observer variability of dobutamine stress CMR in patients with severe coronary disease: implications for clinical research.

PURPOSE: The purpose of this study was to analyze reproducibility and inter-observer variability of dobutamine stress cardiac magnetic resonance imaging (dobutamine CMR) and its implications on serial studies. METHODS: Nineteen consecutive patients underwent two dobutamine CMR each (median 12 days apart), as part of eligibility criteria for phase I/II stem cell therapy trial. These patients had Canadian Cardiovascular Society Class III/IV angina despite maximal therapy. The two studies were compared for reproducibility of stress response. To assess inter-observer variability, 29 randomly selected dobutamine CMR studies were analyzed by three experienced observers and Kappa values were computed to measure the agreement. RESULTS: Dobutamine CMR studies were completed without any major complications. The left ventricular function, dobutamine and atropine dose, hemodynamic response, symptomatic response and the results of wall motion and perfusion abnormalities were highly reproducible between the two studies (p = .91). Sample size calculations suggested that a clinical trial using dobutamine CMR to detect an endpoint of resolution of two ischemic segments would require a sample size of 20 subjects and to detect an improvement in perfusion of two segments would require a sample size of 8 subjects. Inter-observer variability between individual and consensus interpretation of dobutamine CMR was good to very good (kappa = 0.81 for wall motion and 0.70 for perfusion). CONCLUSION: Dobutamine CMR is a highly reproducible technique with very good inter-observer variability and could be used as a specific endpoint in a relatively small clinical trial.

Adrenergic beta-Agonists↗
PubMed2004

Is acupuncture a useful adjunct to physiotherapy for older adults with knee pain?: the "acupuncture, physiotherapy and exercise" (APEX) study [ISRCTN88597683].

BACKGROUND: Acupuncture is a popular non-pharmacological modality for treating musculoskeletal pain. Physiotherapists are one of the largest groups of acupuncture providers within the NHS, and they commonly use it alongside advice and exercise. Conclusive evidence of acupuncture's clinical effectiveness and its superiority over sham interventions is lacking. The Arthritis Research Campaign (arc) has funded this randomised sham-controlled trial which addresses three important questions. Firstly, we will determine the additional benefit of true acupuncture when used by physiotherapists alongside advice and exercise for older people presenting to primary care with knee pain. Secondly, we will evaluate sham acupuncture in the same way. Thirdly, we will investigate the treatment preferences and expectations of both the participants and physiotherapists participating in the study, and explore the effect of these on clinical outcome. We will thus investigate whether acupuncture is a useful adjunct to advice and exercise for treating knee pain and gain insight into whether this effect is due to specific needling properties. METHODS/DESIGN: This randomised clinical trial will recruit 350 participants with knee pain to three intervention arms. It is based in 43 community physiotherapy departments in 21 NHS Trusts in the West Midlands and Cheshire regions in England. Patients aged 50 years and over with knee pain will be recruited. Outcome data will be collected by self-complete questionnaires before randomisation, and 6 weeks, 6 months and 12 months after randomisation and by telephone interview 2 weeks after treatment commences. The questionnaires collect demographic details as well as information on knee-related pain, movement and function, pain intensity and affect, main functional problem, illness perceptions, self-efficacy, treatment preference and expectations, general health and quality of life. Participants are randomised to receive a package of advice and exercise; or this package plus real acupuncture; or this package plus sham acupuncture. Treatment details are being collected on a standard proforma. Interventions are delivered by experienced physiotherapists who have all received training in acupuncture to recognised national standards. The primary analysis will investigate the main treatment effects of real or sham acupuncture as an adjunct to advice and exercise. DISCUSSION: This paper presents detail on the rationale, design, methods, and operational aspects of the trial.

Acupuncture Therapy↗
PubMed2004

Predicting persistent neck pain: a 1-year follow-up of a population cohort.

STUDY DESIGN: A population cohort study to determine the 1-year persistence of neck pain. OBJECTIVES: The aim of this study was to determine the persistence of neck pain over a 12-month period among the general adult population and to explore socio-demographic, health-related, occupational, physical, and lifestyle factors that might be linked to such persistence. SUMMARY OF BACKGROUND DATA: Musculoskeletal clinicians report that neck patients frequently return to consult for recurring episodes of pain. However, the persistent nature of neck pain has been less researched than other common chronic pain syndromes. METHODS: First, to identify a cohort of current neck pain sufferers, a baseline cross-sectional survey was conducted in a general population of 7,669 adults, 18 to 75 years of age, registered with two primary care practices in South Manchester, UK. The second phase was a follow-up survey, 12 months later, to determine the 1-year persistence of neck pain among those who had reported neck pain at baseline. Persistence of neck pain was compared across groups of responders stratified by potential prognostic factors measured at baseline. "Persistent" neck pain was defined according to shading within the region of the neck on a blank body mannequin. The term "persistent" neck pain could therefore reflect chronic, recurrent, or continuous pain. RESULTS: There were 1,359 neck pain responders in the baseline survey, and these subjects formed the study population for the prospective study. At follow-up, 786 (58%) subjects responded, of whom 48% reported having neck pain lasting for more than 1 day, during the previous month. Significant baseline characteristics, which independently predicted persistent neck pain, were age (odds ratio [OR] = 3.4), being off work at the time of the baseline survey (OR = 1.6), comorbid low back pain (OR = 1.6), and cycling as a regular activity (OR = 2.4). CONCLUSION: Among the general population, neck pain persists at 12 months in around half of those who report neck pain at the start of the period. An increased risk of persistent neck pain was associated with age 45 to 59 years and low back pain, and also with cycling. The link with psychological distress and the absence of a link with occupational factors compares with other previous findings for common musculoskeletal syndromes in the community.

Adolescent↗
PubMed2004

The Knee Clinical Assessment Study--CAS(K). A prospective study of knee pain and knee osteoarthritis in the general population.

BACKGROUND: Knee pain affects an estimated 25% of the adult population aged 50 years and over. Osteoarthritis is the most common diagnosis made in older adults consulting with knee pain in primary care. However, the relationship between this diagnosis and both the current disease-based definition of osteoarthritis and the regional pain syndrome of knee pain and disability is unclear. Expert consensus, based on current evidence, views the disease and the syndrome as distinct entities but the clinical usefulness of these two approaches to classifying knee pain in older adults has not been established. We plan to conduct a prospective, population-based, observational cohort study to investigate the relative merits of disease-based and regional pain syndrome-based approaches to classification and prognosis of knee pain in older adults. METHODS: All patients aged 50 years and over registered with three general practices in North Staffordshire will be invited to take part in a two-stage postal survey. Respondents to this survey phase who indicate that they have experienced knee pain within the previous 12 months will be invited to attend a research clinic for a detailed assessment. This will consist of clinical interview, physical examination, digital photography, plain x-rays, anthropometric measurement and a brief self-complete questionnaire. All consenting clinic attenders will be followed up by (i) general practice medical record review, (ii) repeat postal questionnaire at 18-months.

Aged↗
PubMed2004

Juvenile- versus adult-onset depression: multiple differences imply different pathways.

BACKGROUND: Several sources of heterogeneity in major depression have been identified. These include age of onset, presence of co-morbid disorders, and history of childhood sexual abuse. This study examined these factors in the context of the contrast between onset of depression in young women before and after age 16. METHOD: Sampling was carried out in two phases. In the first, questionnaires were sent to women aged 25-36 in five primary care practices. Second-phase subjects for interview (n = 197) were drawn from three strata defined on the basis of childhood adversities. Interviews conducted and rated independently assessed (1) recalled childhood experiences, psychopathology and parental psychiatric disorder, and (2) adult personality functioning and adult lifetime psychopathology. Frequencies of predictor and response variables, effect estimates and their confidence intervals were weighted back to the general population questionnaire sample. RESULTS: Compared with adult-onset depression, juvenile-onset adult depression was associated with co-morbid childhood psychopathology and peer problems, poor parental care, and childhood sexual abuse involving actual or attempted intercourse; in adult life there were higher levels of co-morbid psychiatric disorders, and personality dysfunction. The adult-onset depression group was characterized by a history of contact childhood sexual abuse without actual or attempted intercourse, and to a lesser extent, poor parental care. CONCLUSIONS: The juvenile- versus adult-onset distinction appears to be important to heterogeneity in adult depression, implicating different individual and environmental factors during childhood, and different mechanisms in adult life.

Adolescent↗
PubMed2004

Recalled relationships with parents and perceptions of professional support in mothers of infants treated for cleft lip.

This study examined whether individual differences in perception of the quality of professional support available at a time of stress may be associated with security of attachment. We developed a new measure of parents' perceptions of emotional and practical support provided by a wide range of professionals involved in the treatment of infants with cleft lip. It showed good internal reliability and stability over 4 months. Mothers of 102 infants with cleft lip, with or without cleft palate, completed the measure at 2 and 6 months, together with the Parental Bonding Instrument and the General Health Questionnaire. Mean scores reflecting how much they could trust or talk frankly, or share their worst fears, with professionals, and the extent to which they saw them as a source of useful information or practical help, were lower among mothers with recollections of low maternal care in childhood, or high control. This was the case at 2 and 6 months, and there were some indications of an increasing contribution of low maternal care from 2 to 6 months. The associations were not explained by current depression. Further research is needed to clarify the role of attachment processes in parents' responses to serious medical conditions in their children, and into the implications for the way professionals in paediatric services provide support.

Attitude to Health↗
PubMed2004

Long-term effects of psychological trauma on psychosocial functioning.

BACKGROUND: Most studies of the effects of trauma on mental health have generally not separately assessed psychosocial functioning, and in those that have key issues have received little attention, such as the relation between the time courses of the two kinds of outcome, and detailed assessment of social functioning in a range of domains. The present study made separate assessments with a view to testing four hypotheses. First, that the experience of trauma itself (independently of effects on mental health) has a negative effect on psychosocial functioning; second, that psychopathology following trauma is associated with poorer psychosocial functioning; third, that psychosocial functioning recovers when psychiatric conditions remit; fourth, that post-traumatic stress and depression have different associations with impairments of psycho-social functioning. METHOD: One hundred and fifteen young adults who had survived a shipping disaster (the sinking of the Jupiter in 1988) between 5 and 8 years previously, and 50 control participants were assessed for psychopathology, and for psychosocial functioning using the Adolescent to Adult Personality Functioning Assessment (ADAPFA). RESULTS: Results did not support the first hypothesis: survivors who, although experiencing a traumatic event, did not develop Post Traumatic Stress Disorder or other psychopathology warranting diagnosis, when compared with Controls who had no psychopathology since the time of the disaster, showed no significant differences on any ADAPFA domains or on total score. There was partial support for the second hypothesis: survivors with diagnosable disorder during the rating period showed poorer psychosocial functioning in total ADAPFA score and in the domains of Education/Work, Love Relationships, and Non-specific Social Contacts, though not in other domains. The third hypothesis was supported: recovered Survivors showed no psychosocial impairments compared with unaffected Controls. Results also supported the fourth hypothesis, showing differential effects of post traumatic stress and depression in relation to the extent and kind of psycho-social impairments. CONCLUSIONS: The results lend support to the general model that effects on psychosocial functioning following traumatic experience are mediated by psychopathology, though further research is needed to establish whether the present pattern of findings applies to other kinds of trauma.

Adolescent↗
PubMed2004

The role of overgeneral autobiographical memory in the development of adult depression following childhood trauma.

OBJECTIVE: Overgeneral autobiographical memory (AM) has been associated with episodes of clinical depression in adults and also with reported experience of childhood sexual abuse (CSA). This study investigated whether AM has a role in the development of adult depression in survivors of CSA and whether it is related to circumstances of CSA. METHOD: A community sample of women who reported a history of CSA (N = 41) completed the autobiographical memory test and were interviewed about any adult episodes of depression using the Schedule for Affective Disorders and Schizophrenia-Lifetime. RESULTS: Women who reported episodes of depression recalled fewer categoric memories in response to cue words than those who reported no episodes of depression. Correlations indicated that the number of categoric memories recalled for all cue words was associated with early abuse and greater duration of abuse. CONCLUSIONS: Relationships between AM and the age, and duration of abuse are consistent with previous findings of a relationship between CSA and AM. Categoric AM appears to serve as a defence against distressing memories. However, this suggestion needs to be tested with prospective studies showing whether AM recall style becomes more specific as a result of an episode of depression.

Adult↗
PubMed2003

The Liverpool Violence Assessment: an investigator-based measure of serious violence.

BACKGROUND: Antisocial personality disorder (ASPD) identifies adults with persistent offending behaviour and social dysfunction. However, it lacks discrimination within high-risk and criminal populations and gives little indication of an individual's history of violence. Existing measures of violence have significant limitations. The Liverpool Violence Assessment (LiVA) is an investigator-based standardized interview for measuring patterns of violence. METHOD: A total of 61 male prisoners who had been sentenced for serious violent offences were interviewed using the LiVA and the Structured Clinical Interview for DSM IV antisocial personality disorder and alcohol and drug dependence. Official records of offending were examined. RESULTS: The inter-rater reliability for the LiVA was high. There were significant correlations between histories of violence assessed by the LiVA and official records, but the frequency of self-reported violence was much higher than in the official records. Antisocial personality disorder was associated with increased violence. However, analyses revealed marked variability of the levels of violence among those with antisocial personality disorder and contrasting patterns of association of violence with antisocial personality disorder depending on the context. CONCLUSION: The LiVA is a reliable and valid measure of the patterns and characteristics of violence. The findings suggest that the causes of violence should be studied in their own right and not only as a feature of ASPD.

Adult↗
PubMed2003

Adult psychosocial functioning following childhood cancer: the different roles of sons' and daughters' relationships with their fathers and mothers.

BACKGROUND: Adult survivors of childhood cancer have impaired psychosocial functioning, but not much is known about the causes. In this study we examined the role of relationships with parents as a possible mediating factor. METHOD: One hundred and two adult survivors (82% of those eligible, 35 female and 57 male) of childhood Acute Lymphoblastic Leukaemia and Wilms' Tumour, and 102 matched controls (74% of those eligible) aged 19-30 were interviewed. Interpersonal and social role functioning, and current relationships with each parent were assessed in standardised investigator-based interviews with subjects. RESULTS: Adult survivors were more likely than controls to have impaired close relationships (love relationships and friendships), and poorer day-to-day coping. Lower encouragement from fathers and greater involvement with mothers were each independently associated with impaired close relationships outside the family. This association was evident across the sample and in the cancer survivor group. It was much stronger in young adult females. Lower paternal encouragement was also associated with poor day-to-day coping, and this association was stronger in young men. There was, however, little evidence that quality of relationships with parents mediated the link between childhood cancer and adult psychosocial functioning. CONCLUSIONS: Within this cross-sectional design we could not determine the direction of influence, nor exclude third variable effects. However, the findings indicate that mothers and fathers have different roles in the transition to adult life, and understanding these may assist the development of interventions designed to improve adult psychosocial functioning.

Adult↗
PubMed2003

The ecology of attachment in the family.

In this article we outline a conceptualization of attachment processes within the family. We argue that the key elements of attachment processes are affect regulation, interpersonal understanding, information processing, and the provision of comfort within intimate relationships. Although these have been described and assessed primarily in terms of individual functioning and development, they are equally applicable in family systems, provided three farther steps are taken. First, the description of attachment processes at the individual level is applied to the family using the concept of shared frames or representations of emotions, cognitions, and behaviors. Second, there is an explicit formulation of the way in which individual and family processes are linked. Third, there is a conceptualization of the nature and quality of the dynamic between attachment and other processes in family life. In this "ecology" of family processes, those that entail heightened affect and a need to create certainty through action, particularly in response to threats to safety, attachment needs, and discipline challenges, are contrasted with exploratory processes characterized by low affect, tolerance of uncertainty, and opportunities to review existing assumptions and knowledge.

Affect↗
PubMed2003

Early identification of individuals at risk for antisocial personality disorder.

BACKGROUND: Antisocial personality disorder is usually preceded by serious and persistent conduct problems starting in early childhood, and so there is little difficulty in identifying an at-risk group. AIMS: To address six key areas concerning the relationship between early conduct problems and antisocial personality disorder. METHOD: Review of recent research into early identification of and intervention in child conduct problems, following up to possible adult antisocial behaviour. RESULTS: Conduct problems are predictive of antisocial personality disorder independently of the associated adverse family and social factors. Prediction could be aided through identification of subtypes of conduct problems. There is limited evidence on which children have problems that are likely to persist and which will improve; children who desist from early conduct problems and those with onset in adolescence are also vulnerable as adults. CONCLUSIONS: The predictive power of the childhood precursors of antisocial personality disorder provides ample justification for early intervention. Greater understanding of subgroups within the broad category of antisocial children and adults should assist with devising and targeting interventions.

Adolescent↗