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Biomedical subjects

P Barron

Publications and source records attributed to P Barron.

At least 19 recordsLinked to original sources
PubMed2004

Offenders with intellectual disability: a prospective comparative study.

BACKGROUND: Intellectually disabled offenders (IDO) are a poorly served and under-recognized group, who are likely to require long-term specialist treatments and interventions. METHOD: This prospective study investigated the characteristics and factors that influence outcome in this group, with particular reference to therapeutic interventions. Sixty-one individuals were identified from contact with either (1) specialist health and social services for people with intellectual disability (ID) or (2) nonspecialist services in the criminal justice or (forensic) mental health/social service systems. The participants were assessed at baseline and after a mean of 10 months in order to compare recidivism rates and the impact of therapeutic interventions. RESULTS: The findings suggest that IDO start offending at an early age, that they frequently have a history of multiple offences, and that sex offending and arson are over-represented offence types. Those participants recruited from nonspecialist ID services had significantly higher IQs and were less likely to have had contact with community social and health support agencies. Despite the high rates of psychopathology, there was little evidence for efficacy of therapeutic interventions, which, where offered, appeared to be of a nonspecific nature. At second interview, approximately half of the sample had re-offended.

Adult↗
PubMed2002

Offenders with intellectual disability: the size of the problem and therapeutic outcomes.

BACKGROUND: People with intellectual disability (ID) who offend may be subject to a variety of dispositions within the criminal justice system, or via diversion to health and social services in inpatient units or in community ID teams. Offenders with ID are a group with complex needs who may pose a recurrent risk to the public. Despite the significant number of offenders with ID, there is limited evidence on treatment effectiveness and outcomes. METHODS: A literature search of all electronic databases was undertaken, and journals were hand-searched for clinical trials or case studies of interventions for offenders with ID. The main outcome was recidivism rates. RESULTS: There were no published clinical trials of offenders with ID. A series of small-scale group cognitive-behavioural treatments for sex offenders offers the most persuasive evidence of success in reducing recidivism. CONCLUSION: Offenders with ID often receive inadequate services as a result of poor identification through the criminal justice system and research into effective treatments is rudimentary. Further studies are necessary in order to improve treatment efficacy and service provision for a complex group of individuals.

Behavior Therapy↗
PubMed2001

Local recurrence after curative resection of cancer of the rectum without total mesorectal excision.

PURPOSE: The aim of this article was to examine local recurrence after curative resection for carcinoma of the rectum in which the surgical technique of total mesorectal excision was not performed. METHODS: A single surgeon managed the patients and the data collected prospectively. Total excision of the distal mesorectum was not performed in the upper third or mid rectum. RESULTS: From 1969 to 1993 curative resections were performed in 549 patients, of which 17 died postoperatively, leaving 532 for analysis. Sphincter-saving resection was performed in 468 patients (88 percent) and abdominoperineal excision in 58 (10.9 percent). The pathology stages (Dukes) were A, 158 (29.7 percent); B, 184 (34.7 percent); and C, 190 (35.7 percent). Five hundred seventeen patients (97.2 percent) were followed up for a minimum of five years. The median period of follow-up was 82 months. Local recurrence confined to the pelvis occurred in 17 patients, and local recurrence associated with distant metastases occurred in 24 patients. The total five-year local recurrence rate was 7.6 percent. Local recurrence was increased in Stage C tumors (P = <0.0001). Diathermy dissection in the pelvis was associated with a decreased local recurrence rate (P = 0.023). The five-year survival rate in curative resections was 72.5 percent. CONCLUSIONS: It is essential that articles presenting local recurrence rates should include both local recurrence in isolation and that which occurs with distant metastases. Although total mesorectal excision for rectal cancer was not performed in this study, the local recurrence rate is not materially different from that in several articles where total mesorectal excision has been used. Whether the distal mesorectum needs to be pursued in mid-rectal cancer is not yet proven.

Adult↗
PubMed1997

Why wait so long for child care? An analysis of waits, queues and work in a South African urban health centre.

Long waits at large urban clinics obstruct primary care delivery, imposing time costs on patients, deterring appropriate utilization and causing patient dissatisfaction. This paper reports on an innovative attempt by staff in a large South African urban health centre to analyse a system of queues and preventive and curative services for pre-school children, and thereafter to evaluate changes. The study had a cross-sectional work study design, with repeated measurement of waiting times after 13 months. At baseline the preventive clinic was found to have several inessential processes and waits; these were eliminated or overlapped, and clinic sessions per week were increased. A year later median waiting times had decreased substantially in the preventive clinic, but had increased in the curative clinic. Simple research can explain long waits, inform and measure changes, and provide evidence to justify primary care integration and would be useful in health centres and hospital outpatient departments in developing countries.

Appointments and Schedules↗
PubMed1996

Infant mortality rate inequalities in the Western Cape Province of South Africa.

BACKGROUND: Cape Town is undergoing rapid urbanization. South African vital statistics have routinely been stratified by racial categories but intra-urban and peri-urban geographical variations have been neglected. METHODS: To examine variations in infant mortality rates (IMR) and proportional infant mortality between urban, rural and informally settled areas, stratified by racial category, birth notifications and infant death certifications recorded by a large health authority were analysed. RESULTS: The IMR per 1000 livebirths was as high for coloureds on rural farms (34, 95% confidence interval 29-40) as for blacks in informal settlements (35, 95% CI: 32-37) and an exceptionally high IMR (60, 95% CI: 43-82) was found for coloureds in informal settlements. Inequalities between racial categories (11 (95% CI: 9-14) for whites, 19 (95% CI: 18-21) for coloureds and 33 (95% CI: 31-35) for blacks) were as expected from other South African studies. Of rural farm deaths, 22% were ascribed to ill-defined causes. Low birthweight was the most common defined cause of death in all areas except rural farm areas (14% ascribed to pneumonia), and gastro-enteritis was important in informally settled areas (18%). CONCLUSIONS: Routine mortality data are more informative if stratified by robust and readily available indicators of socio-economic status such as residential area and racial category. Place of residence may distinguish risk strata as well as racial category, but the latter is helpful within socioeconomically heterogeneous residential areas.

Black or African American↗
PubMed1996

The effect of Edmonston-Zagreb and Schwarz measles vaccines on immune response in infants.

The effects of measles immunization on immune responses in infants and the roles of vaccine strain and age of immunization are not known. Eighty-eight children were immunized at 6 or 9 months of age with the Edmonston-Zagreb (EZ) or Schwarz (SW6, SW9) strain of measles vaccine. Children were studied before and 2 weeks and 3 months after immunization. Seroconversion was similar, but geometric mean neutralizing titers at 3 months differed by vaccine group: SW9, 1367 mIU/mL; SW6, 982; and EZ, 303 (P = .003). Mitogen-induced lymphoproliferation was decreased at 2 weeks in the SW9 group and at 3 months in all groups and was negatively correlated with measles antibody level at 3 months (r = -.387, P = .003). CD8 T cells, soluble CD8, neopterin, and beta2-microglobulin were increased at 2 weeks in the SW9 group, and soluble CD8 and beta2-microglobulin remained elevated at 3 months. Therefore, measles immunization resulted in suppression of lymphoproliferation, which was most evident in infants with the highest antibody responses and most immune activation.

Age Factors↗
PubMed1996

Missed opportunities for immunisation in curative and preventive services in a community health centre. A follow-up survey.

OBJECTIVES: To compare prevalences of missed opportunities for immunisation between preventative and curative clinic patients and to evaluate changes 13 months later. DESIGN: Repeat cross-sectional survey of patients' Road to Health cards. SETTING: A large community health centre in Khayelitsha, South Africa. PARTICIPANTS: Patients under 6 years of age. MAIN OUTCOME MEASURES: Proportion of children needing immunisation who were not vaccinated during the visit. RESULTS: At baseline, prevalences (95% confidence intervals) of missed opportunities or immunisation were 15.7% (9.2 - 22.2%) among preventative clinic patients and 92.0% (85.9 - 98.1%) among curative clinic patients. Thirteen months later the respective prevalences were 12.0% (5.0 - 19.0%) and 90.5% (84.6 - 96.4%). CONCLUSIONS: Separate provision of curative and preventive paediatric care results in many missed opportunities for immunisation in the former service. Fewer opportunities are missed if immunisation services are available all day every day, rather than for limited periods of the week.

Child, Preschool↗
PubMed1995

Sex differences in patients admitted to a regional secure unit.

The case notes of all admissions to a Regional Secure Unit over a 12-year period were examined. A higher proportion of females had a diagnosis of personality disorder. Women were less likely to have a prosecuted offence associated with admission but were more likely to be charged with fire-setting. Patients with personality disorder were more likely to be transferred to special hospitals. Women were nearly three times as likely as men to be transferred to maximum security and this was not accounted for by the excess of females with personality disorder. There was net movement of men out of special hospitals whereas the opposite was true for women. Possible explanations for this are discussed.

Adolescent↗
PubMed1995

Towards a rational cervical cytology screening strategy. Case study of a peri-urban settlement.

OBJECTIVES: To assess cervical cytology screening activity in a peri-urban settlement near Cape Town, with a view to informing rational policy development. METHOD: Total and age-specific prevalence rates of women who had been screened, relative prevalence by age group of women who had not been screened, and yield of screening were estimated from cytopathology laboratory records and available demographic data. Age-specific prevalence rates among women who had been screened were compared with age at presentation with cervical cancer at the referral hospital. Attendance for colposcopy follow-up was assessed from colposcopy clinic records. RESULTS: The number of smears taken and the prevalence of women who had been screened peaked in the 20 - 24-year age group, and declined to low levels in those over the age of 40 years. The relative prevalence of those who had not had a smear exceeded 9 in all age groups over 39 years, compared with women of 20 - 24 years. Smears which showed signs of CIN III, malignancy or possible malignancy comprised 0.13%. Thirty-six per cent of women booked for colposcopy did not attend. CONCLUSIONS: Efficiency of screening could be improved by emphasising coverage of higher-risk age groups, e.g. women over the age of 30 years, and better follow-up.

Adolescent↗
PubMed1995

Hemipancreatectomy, peripheral diversion of pancreatic venous drainage, and insulin sensitivity.

It has been previously noted that a mild insulin deficiency could increase insulin sensitivity in rats. The data shown here are consistent with such an observation in that the insulin resistance, which was induced by diversion of pancreatic venous drainage to the peripheral circulation, was corrected by the insulin deficiency which was secondary to the hemipancreatectomy performed. These results also help to explain some of the apparent inconsistencies that appear to be present in the comparison often made of insulin sensitivity following various transplantation procedures. Both the site of pancreatic venous drainage and any decrease in beta-cell mass which may accompany pancreas or islet transplantation appear to have independent and opposite effects on insulin sensitivity.

Animals↗
PubMed1994

The 1992 measles epidemic in Cape Town--a changing epidemiological pattern.

Over the last 6 years there has been a decline in the incidence of measles in Cape Town. However, during August 1992 an outbreak occurred, with cases reported at many schools in children presumably immunised. The objectives of this study were to characterise the epidemic in Cape Town and to determine possible reasons for the outbreak. The investigation consisted of two components--a description of the epidemic and an investigation of an outbreak at one primary school. Results indicate that during the last 4 months of the year, 757 cases were notified in Cape Town, compared with 144 in the first 8 months. The epidemic affected mainly white and coloured children over 5 years of age (P < 0.001). In contrast, during the period before the epidemic most cases occurred in black children and in those aged less than 1 year (P < 0.001). There was no significant increase in hospitalised cases. Investigation of the outbreak at one school revealed that the attack rate was 7.6% (25/329 children). Immunisation coverage (at least one dose of any measles vaccine) was 91% and vaccine efficacy was estimated to be 79% (95% CI 55-90); it was highest for monovalent measles (100%) and lowest for measles-mumps-rubella (74%). The epidemiology of measles in Cape Town has thus changed as evinced in this epidemic, with an increase in the number of cases occurring in older, previously vaccinated children. The possible reasons for this include both primary and secondary vaccine failure.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗