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Biomedical subjects

N Donnelly

Publications and source records attributed to N Donnelly.

At least 37 records · Page 2Linked to original sources
PubMed1996

Insomnia in general practice. Results from NSW General Practice Survey 1991-1992.

OBJECTIVE: To assess whether an educational visit to GPs providing information about the non-drug and drug management of anxiety and insomnia can reduce subsequent rates of benzodiazepine prescription. METHOD: A randomised controlled trial of 286 NSW general practitioners conducted during 1991 and 1992. RESULTS: The educational visit was statistically significant in reducing the number of new prescriptions recorded by general practitioners for new diagnoses of insomnia. However, the majority of benzodiazepine prescriptions were for patients continuing treatment for insomnia or anxiety/depression. Overall, benzodiazepines were the sole management of insomnia recorded by the surveyed GPs in most cases (93.5%). In comparison, non-drug management for anxiety and depression was offered to more than a third of patients with anxiety and depression. (Benzodiazepines were the only management of anxiety and depression in just over 50% of cases.) DISCUSSION: This study shows general practitioners can change their management of insomnia and that change is most likely to occur when the problem is new, rather than old. The decreased emphasis on drug treatment in the general practice management of anxiety and depression may reflect the change in psychiatric teaching for these conditions. Further, most of the publicity about benzodiazepines has been in relation to their use for anxiety disorders. Doctors were interested in learning about advances in the understanding of sleep disorders and their non-drug management.

Australia↗
PubMed1995

Benzodiazepine prescribing in general practice: dispelling some myths.

The objective was to analyse clinical and non-clinical factors associated with the receipt of a prescription for a benzodiazepine among general practice patients. A survey of 110 consecutive patient encounters (consultations) as recorded by a representative sample of general practitioners in inner urban, outer urban and rural settings was designed. A total of 286 general practitioners took part during 1991-2. 31,256 patients (10,683 male; 34%) were surveyed and the odds of receiving a benzodiazepine script measured. Insomnia, unlike anxiety, was almost routinely managed with a benzodiazepine alone (insomnia 89.6%; anxiety 49.4%), whereas anxiety was more likely to be managed with non-drug management (insomnia 7.2%; anxiety 38.3%). In multiple logistic regression, the variables significantly associated with the prescription of a benzodiazepine included being a female patient, being an older patient and being an established patient, who attends a GP working in a busy practice in an inner urban area. A second regression model was run with the addition of three variables, namely the presenting problems of anxiety and insomnia, and the number of health problems. The only predictors of benzodiazepine prescribing in the full model were these three clinical variables together with patient age. There is a need to educate doctors about the non-drug management of insomnia. The stereotype of the doctor over-prescribing a benzodiazepine without an appropriate problem/diagnosis should be questioned. On the other hand, there is concern that patient age continues to be associated with a prescription of these medications, when all other clinical and non-clinical factors are taken into account.

Adolescent↗
PubMed1995

A controlled trial of educational visiting to improve benzodiazepine prescribing in general practice.

A randomised controlled trial studied the effect of an educational visit on benzodiazepine prescribing. An approximately representative sample of 286 general practitioners was allocated to an intervention or a control group. Rates of benzodiazepine prescriptions were derived from two comprehensive self-report surveys seven months apart. Two months after the first survey the intervention group received an educational visit and supporting material from a doctor or pharmacist, ostensibly unconnected with the surveys. The overall benzodiazepine prescribing rate fell by 23.7 per cent from the first to the second surveys, from 4.93 to 3.76 prescriptions per 100 encounters (P < 0.001). Anxiety and insomnia diagnosis rates also declined from 4.68 to 3.76 per 100 encounters (19.7 per cent). After adjusting for confounders, there was a differential downward trend in prescriptions per diagnosis of insomnia but not to a statistical level. The same was true of initial prescriptions per insomnia diagnosis. In a subsidiary analysis selecting only new insomnia diagnoses, the intervention had a strong effect in reducing initial prescriptions (odds ratio 0.18, 95 per cent confidence interval 0.04 to 0.73). No effect was seen on prescribing for anxiety diagnoses. Educational practice visiting for benzodiazepine prescribing in anxiety, as we conducted it, is not justified in an unselected population of general practitioners. Specific education on prescribing for insomnia is probably useful. Our interpretation of the reduction in benzodiazepine prescribing is that probably there was an effect from self-monitoring alone which overwhelmed a main-analysis intervention effect. Retrospective diagnosis may also have obscured a real intervention effect.

Anti-Anxiety Agents↗
PubMed1995

A prospective cohort study investigating psychosocial predictors of attendance at a mobile breast screening service.

This study aimed to examine whether knowledge, attitudes and concerns predicted attendance at the mobile Breast X-Ray Programme in Sydney. A cohort study design was used, whereby women were surveyed prior to the implementation of the program, and two years later records were checked to determine whether they had attended for screening. Telephone interviews were sought with randomly selected women aged 45 to 70 years living in the central Sydney area (the screening van's catchment area). A total of 285 women was surveyed (response rate: 50 per cent). Of these, 86 (30 per cent) subsequently attended at the mobile van and 199 did not. Attendance did not appear to be related to any of the following factors: knowledge; attitudes; prior experience; perceived susceptibility and morbid concern in relation to breast cancer; the amount of information about screening mammography to which a woman had been exposed. The results are interpreted in light of methodological considerations plus findings from our other research.

Aged↗
PubMed1995

The effects of partial decriminalisation on cannabis use in South Australia, 1985 to 1993.

In 1987 the Cannabis Expiration Notice scheme decreased penalties for the personal use of cannabis in South Australia. Data from four National Campaign Against Drug Abuse (NCADA) household drug-use surveys covering the period 1985 to 1993 were analysed to measure the effect of the decriminalisation on cannabis use. The main outcomes used were the self-reported prevalence rates of having ever used cannabis and current weekly use. Logistic regression was used to control for the potentially confounding effects of age and sex. Other outcomes were rates of having ever been offered cannabis and willingness to use cannabis if offered it. Between 1985 and 1993 the adjusted prevalence rate of ever having used cannabis increased in South Australia from 26 per cent to 38 per cent. There were also significant increases in Victoria and Tasmania, and to a lesser extent in New South Wales. The increase in South Australia was not significantly greater than the average increase (P = 0.1). Adjusted rates of weekly use increased between 1988 and 1991 in South Australia, but did not change through 1993. Although the effect was in the direction of a greater increase in South Australia, this was not statistically significant when compared to increases in the rest of Australia (P = 0.07). The greatest increase in adjusted weekly use occurred in Tasmania between 1991 and 1993, from 2 per cent to 7 per cent. Although the NCADA survey data indicate that there were increases in cannabis use in South Australia in 1985-1993, they cannot be attributed to the effects of partial decriminalisation, because similar increases occurred in other states.

Adolescent↗
PubMed1994

Stimulus factors affecting the categorisation of faces and scrambled faces.

Three experiments are reported which investigate the categorisation of faces and scrambled faces in a face/scrambled face decision task. Three kinds of stimuli were presented in upright and inverted orientations; faces, highly scrambled faces (all features out of position) and moderately scrambled faces (two features out of position). Experiment 1 demonstrated that faces and highly scrambled faces are categorised equally quickly and both types of stimulus were categorised faster than moderately scrambled faces. These results held for both upright and inverted presentations. It is argued that for both upright and inverted presentations, faces are categorised by being matched in parallel to a stored mental representation of a face. In contrast scrambled faces are categorised following a serial search of facial features which is probably self-terminating. Experiment 2 demonstrates that the results of Experiment 1 hold when facial features are replaced by other objects which retain the same global shape as facial features and suggest that faces are categorised using a coarsely coded visual description. Experiment 3 demonstrates the importance of stimulus outline on the categorisation of both moderately and highly scrambled faces but not real faces. The results are discussed in terms of the stimulus information used, and the effect of inversion, on face categorisation.

Face↗
PubMed1994

The psychosocial impact of implementing a mammography screening campaign in an Australian community.

We examined the psychosocial impact of implementing a generalised campaign to promote mammography screening in an Australian inner city community. Prior to the campaign, telephone interviews were conducted with 628 randomly selected women aged 45-70, 285 in central Sydney (where the screening programme operated) and 343 from the rest of Sydney. A second cross-sectional survey was conducted two years after the campaign commenced. The campaign achieved an estimated 21% attendance rate in an eligible population of 43,000 women over a period of 22 months. Overall the campaign reached a large section of the eligible community, with 70% of women being aware of the van's existence. In addition, the proportion of women who reported being exposed to 'a moderate amount' or 'quite a lot' of information about screening increased by almost 20%. However, two thirds of women still reported being exposed to 'only a little' or no information at all. Attendance was achieved largely in the absence of improvements in knowledge and attitudes. Where change did happen, it occurred in the community overall, rather than being confined to the campaign's target area. Changes were most likely due to general electronic and print media messages, which were largely positive in their tone of reporting on screening. The campaign in one area of central Sydney, Drummoyne, which was much more intense, was successful in encouraging greater awareness of the van and mammography screening, plus greater attendance than in the rest of central Sydney, but had no impact on knowledge or attitudes. There was no demonstrable impact on psychological morbidity.

Adult↗
PubMed1994

Search via recursive rejection (SERR): visual search for single and dual form-conjunction targets.

Models of visual search that assume spatially serial processing of conjunction stimuli break down when displays contain 2 identical conjunction targets: (a) They fail to account for the slopes of the target-absent reaction time (RT)/display size functions, both when the target-present response requires the detection of only 1 of the 2 targets and when it requires the detection of both targets and (b) under redundant target conditions, the probability of "fast" present RTs is greater than that expected from the independent (serial) processing of the target stimuli. This article shows that G. W. Humphreys and H.J. Müller's (1993) parallel search via recursive rejection (SERR) model can account for human search performance under dual-target conditions. In SERR, simple form conjunctions are coded and grouped (on the basis of their similarity) in a spatially parallel manner, and targets are detected through the activation of a temporary "template" or through the recursive rejection of grouped distractors.

Adult↗
PubMed1994

Parallel visual coding in three dimensions.

Evidence from visual-search experiments is discussed that indicates that there is spatially parallel encoding based on three-dimensional (3-D) spatial relations between complex image features. In one paradigm, subjects had to detect an odd part of cube-like figures, formed by grouping of corner junctions. Performance with cube-like figures was unaffected by the number of corner junctions present, though performance was affected when the corners did not configure into a cube. It is suggested from the data that junctions can be grouped to form 3-D shapes in a spatially parallel manner. Further, performance with cube-like figures was more robust to noncollinearity between junctions than was performance when junctions grouped to form two-dimensional planes. In the second paradigm, subjects searched for targets defined by their size. Performance was affected by a size illusion, induced by linear-perspective cues from local background neighbourhoods. Search was made more efficient when the size illusion was consistent with the real size difference between targets and nontargets, and it was made less efficient when the size illusion was inconsistent with the real size difference. This last result occurred even though search was little affected by the display size in a control condition. We suggest that early, parallel visual processes are influenced by 3-D spatial relations between visual elements, that grouping based on 3-D spatial relations is relatively robust to noncollinearity between junctions, and that, at least in some circumstances, 3-D relations dominate those coded in two-dimensions.

Analysis of Variance↗
PubMed1994

Educational visiting and hypnosedative prescribing in general practice.

Public concern about the prescription of hypnosedative drugs (mostly benzodiazepines) led to a controlled trial of an educational intervention to promote rational prescribing by general practitioners (GPs). This paper describes the educational intervention and its process evaluation. In urban and rural New South Wales 137 GPs were visited in office hours by a GP or pharmacist who had undergone communication skills training. Material offered to GPs included relaxation tapes and a booklet of problem-orientated management guidelines. The interview had three stages: rapport was established, then educational material was introduced and finally the visitor sought the doctor's agreement to review five patients on long-term benzodiazepines. The visits were well received. Several measures were composed to reflect doctors' motivation and interest in non-drug management; there was virtually no correlation between any of these process measures and the trial outcome: a change in prescribing behaviour. Self-rating of benzodiazepine prescribing greatly underestimated actual self-reported incidents of prescribing. We interpret this as a reminder that we do not always do what we mean to do, and that we do not always do what we think we do.

Anti-Anxiety Agents↗
PubMed1993

Expression is computed separately from facial identity, and it is computed separately for moving and static faces: neuropsychological evidence.

We report data contrasting the processing of facial identity from static photographs, and facial expression from static and moving images, in two patients with face processing impairments. One patient is markedly impaired at perceiving facial identity and he is poor at discriminating facial expression and gender from static photographs of faces. In contrast, he performs normally when required to make judgements of facial expression and gender to faces depicted by sets of moving light dots. The second patient is relatively good at perceiving facial identity, but poor at judging emotional expression from both static and moving faces. The data are consistent with the existence of separate processes for encoding face identity and facial expression, and, furthermore, indicate the separate encoding of expression from moving and static images.

Cerebrovascular Disorders↗
PubMed1992

Parallel pattern processing and visual agnosia.

A series of visual search experiments are reported examining pattern processing in a visual agnosic patient. We examined search for targets defined by: (I) the combination of their features relative to homogeneous distractors; (2) the combination of their features relative to heterogeneous distractors; and (3) a single feature difference relative to the distractors (their orientation). Normal subjects demonstrate evidence of spatially parallel search when combined-feature targets are detected against homogeneous distractors, and when targets are defined by a salient feature difference. There are non-linear effects of the number of distractors present, and absent responses can be as fast as present. In contrast, search times for combined-feature targets amongst heterogeneous distractors increase linearly with display size, with the slope for absent responses about twice that for present. The contrast between search for combined-feature targets amongst homogeneous and heterogeneous distractors can be attributed to the effects of grouping between distractors and between distractors and targets (Duncan & Humphreys, 1989, 1992; Humphreys & Muller, in press). Grouping between homogeneous distractors facilitates search. An agnosic patient, HJA, showed normal search functions for single-feature targets and for combined-feature targets amongst heterogeneous distractors. However, he was impaired at search for combined-feature targets amongst homogeneous distractors. This suggests that HJA is selectively impaired at grouping conjunctions of form features. The relations between HJA's agnosia and his problem in the parallel grouping of form conjunctions are discussed, as are the implications of the work for understanding normal vision.

Adult↗
PubMed1992

Prevalences and perceptions of licit and illicit drugs among New South Wales secondary school students, 1989.

This paper presents findings on drug prevalences for licit and illicit drugs among New South Wales secondary school students (n = 3753) in late 1989. It also considers the accuracy of students' perceptions of the drug causing the most and fewest drug-related deaths. Data were analysed by age and gender, using logistic regression for the prevalence data. Findings indicate that licit drugs (tobacco, alcohol and analgesics) were the most frequently and widely used. Rates for illicit drugs were low, although there was some degree of experimental use of cannabis which increased amongst older males. Perceptions were found to be inaccurate in emphasising the dangers of the illicit drug heroin over those of the licit drugs tobacco and alcohol. Reasons for these findings are discussed, and more in-depth research recommended into the relationship between drug prevalences and perceptions for different age groups, and its relevance for planning drug prevention initiatives.

Adolescent↗
PubMed1992

Changes in reported drug prevalence among New South Wales secondary school students, 1983 to 1989.

Three drug use surveys employing a standardised questionnaire format and sampling procedure were conducted on samples of New South Wales school students in 1983, 1986 and 1989. Alcohol and tobacco were the most frequently used substances across the surveys, with rates of use of illicit substances being considerably lower. Declines in the prevalence of alcohol, tobacco and stimulant use were found between 1983 and 1986 and between 1986 and 1989 for both males and females. Rates of use of inhalants, sedatives, hallucinogens and narcotics declined between 1983 and 1986, but remained unchanged between the 1986 and 1989 samples. Cannabis use declined significantly among females between 1983 and 1989, but not among males. Possible reasons for the general decline in drug use over the six-year period are discussed.

Adolescent↗
PubMed1991

Parallel computation of primitive shape descriptions.

This article reports evidence that parallel search functions can occur when heterogeneous conjunction elements configure into a single object description. Experiment 1 demonstrates parallel search for form conjunctions presented in displays of heterogeneous nontargets when closure and good continuation between display elements are exhibited. When closure and good continuation are absent, reaction times increase linearly with set size (Experiment 2). Experiment 3 demonstrates a halfway stage between these two extremes, in which displays have closure but not good continuation. Finally, selection of object descriptions is shown to be temporally limited to one object at a time (Experiment 4). The data are incompatible with both local feature-based and distractor similarity-based accounts of visual search; however, they are compatible with there being an important role for preattentive feature combinations forming primitive object descriptions. Parallel search functions can occur when heterogeneous conjunctions configure into a single object description.

Adult↗
PubMed1990

Object superiority: a comparison of complete and part probes.

Previous research on object superiority effects has shown that certain contexts enhance the recognition of an object part. However, those contexts would not normally be called objects. The present study discusses object superiority within more general issues of object recognition. By using what we call 'complete' probes, superiority effects were extended to exposure durations much longer than those used in previous research. Experiments 1 and 2 found that complete probes gave stable superiorities at 250 msec and even 2-sec stimulus exposures. These object superiority effects were found for both objects (faces and chairs) investigated. Experiment 3 showed that object superiorities established with complete probes were not necessarily greater than those for part probes. The experiments stress the role of spatial arrangement of object parts in accessing stored information. It is argued that a successful match of a structural description to a representation in long-term memory influences stimulus processing by allowing the formation of higher level features.

Adult↗
PubMed1986

A study of depression in nursing homes.

The Geriatric Depression Scale (GDS) was used to screen for depression among residents of six nursing homes in Sydney. Of the 61% who could answer the questionnaire, more than one third were depressed. Those who were physically disabled, and those admitted in the previous 3 months scored higher on the GDS. Many of the severely demented patients could be tested with the GDS.

Aged↗