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Biomedical subjects

P Griffiths

Publications and source records attributed to P Griffiths.

At least 91 records · Page 5Linked to original sources
PubMed1996

Cytomegalovirus retinitis in AIDS patients: influence of cytomegaloviral load on response to ganciclovir, time to recurrence and survival.

OBJECTIVES: Despite life-long maintenance therapy, cytomegalovirus (CMV) retinitis frequently progresses in patients with AIDS. Virological markers that could clarify pathogenesis and identify risk factors for progression are required. DESIGN AND METHODS: We prospectively recruited 45 patients with CMV retinitis. Blood and urine samples were collected before and after induction therapy, and on a monthly basis thereafter during routine medical and ophthalmological assessment, and at any time retinitis progressed. CMV load was measured by quantitative-competitive polymerase chain reaction (PCR). RESULTS: The median time to first progression of retinitis was 78 days and to death was 8.7 months. Eighty-five per cent of patients who were PCR-positive at diagnosis of retinitis became PCR-negative after 21 days of ganciclovir induction therapy. Six patients who remained PCR-positive after 21 days of treatment had a significantly higher CMV load at presentation (P = 0.005), and a shorter time to first progression of retinitis of 40 days. High CMV loads in blood at presentation were associated with a shorter time to progression (P = 0.16; relative hazard, 1.57) and a significantly shorter time to death (P = 0.004; relative hazard, 1.76). This significant relationship with survival remained after adjustment for potential confounding variables (CD4 count, age, method of drug administration). CONCLUSIONS: We conclude that CMV load in the blood of AIDS patients is an important factor in the pathogenesis of retinitis, and quantification of CMV could be used to both select patients for controlled clinical trials and to optimize individual anti-CMV induction therapy.

AIDS-Related Opportunistic Infections↗
PubMed1996

Pyridoxine-dependent seizures: demographic, clinical, MRI and psychometric features, and effect of dose on intelligence quotient.

A regional population-based survey identified six patients with pyridoxine dependency. Four presented on the first day of life and the other two at 1 and 8 months of age. Apart from multiple seizure types, other presenting features included jitteriness; encephalopathy, at first thought to be hypoxic-ischaemic; hepatomegaly, and abdominal distension with bilious vomiting. Later problems included break-through fits with fever; transient visual agnosia; squint; severe articulatory apraxia; motor delay with later dyspraxia; macrocephaly, and post-haemorrhagic hydrocephalus. Magnetic resonance imaging showed variable structural abnormalities in all the early onset cases. Psychometric assessment revealed a stereotyped pattern of intelligence scale subtest scores, with a specific impairment of expressive verbal ability. In a prospective open study over one year, an increased dose of pyridoxine was associated with an improvement in IQ, particularly in performance subtests. Pyridoxine dependency is more common than has been thought. It has a wider range of clinical features than the classical neonatal seizures and causes specific impairments of higher function, some of which may be reversible. The dosage of pyridoxine should be optimal for IQ as well as seizure control.

Adolescent↗
PubMed1996

The differences between male and female drug users: community samples of heroin and cocaine users compared.

Although gender-related issues are often cited as playing an important part in determining patterns of illicit drug use, little is known about the differences between male and female drug users outside treatment settings. In the present study, 558 heroin and cocaine users recruited from a range of community settings were interviewed by Privileged Access Interviewers. The women were found to be younger than the men. Differences existed in their drug use; women used smaller amounts, for a shorter duration, and were less likely to inject than their male counterparts. No differences existed between treatment contact for the heroin users, but differences were found among the cocaine-using sample, with men being more likely to have contacted a treatment agency. Men were financing themselves through more criminal activities than women. Drug-using sexual partners were found to be an important influence over women's drug use, with most female injectors having been given their first injection by a male sexual partner. Structural differences in patterns of drug use found among female drug users and the influence of male sexual partners are likely to play an important role in determining appropriate treatment options for women drug users.

Adolescent↗
PubMed1996

Dealing with complaints: procedural changes.

Many complaints can be dealt with by the staff immediately concerned. Complaints procedures have been criticised as being too complicated. New procedures will extend the terms of reference of the Health Service Commissioner and should simplify the complaints procedure.

Hospital-Patient Relations↗
PubMed1995

The Severity of Dependence Scale (SDS): psychometric properties of the SDS in English and Australian samples of heroin, cocaine and amphetamine users.

The Severity of Dependence Scale (SDS) was devised to provide a short, easily administered scale which can be used to measure the degree of dependence experienced by users of different types of drugs. The SDS contains five items, all of which are explicitly concerned with psychological components of dependence. These items are specifically concerned with impaired control over drug taking and with preoccupation and anxieties about drug use. The SDS was given to five samples of drug users in London and Sydney. The samples comprised users of heroin and users of cocaine in London, and users of amphetamines and methadone maintenance patients in Sydney. The SDS satisfies a number of criteria which indicate its suitability as a measure of dependence. All SDS items load significantly with a single factor, and the total SDS score was extremely highly correlated with the single factor score. The SDS score is related to behavioural patterns of drug taking that are, in themselves, indicators of dependence, such as dose, frequency of use, duration of use, daily use and degree of contact with other drug users; it also shows criterion validity in that drug users who have sought treatment at specialist and non-specialist agencies for drug problems have higher SDS scores than non-treatment samples. The psychometric properties of the scale were good in all five samples, despite being applied to primary users of different classes of drug, using different recruitment procedures in different cities in different countries.

Adult↗
PubMed1995

Progress in measuring nursing outcomes.

This paper examines the progress made in the measurement of the 'outcomes' of nursing. Although nursing has a long history of outcome research which extends as far back as Florence Nightingale, an examination of the literature over the past 30 years gives little impression of progress. Significant difficulties still remain in identifying outcomes relevant to nursing intervention, measurement techniques and appropriate study designs. However, progress has been made. The paper examines various recent trends which point to ways forward for outcome research. In particular it is emphasized that future work should build upon the strengths of past work in the use of measurement tools and the identification of relevant variables. Outcome research in nursing should not be limited to identifying the immediate results of nursing intervention, nor should research into 'structure' or 'process' variables be neglected. Such concepts are vital to determining the nursing contribution to changes in a patient's health and well being. The future of outcome research depends on a range of appropriate research methods and measurement techniques.

History, 20th Century↗
PubMed1995

Female prostitutes in south London: use of heroin, cocaine and alcohol, and their relationship to health risk behaviours.

The present study looks at the association between drug and alcohol use and sexual risk behaviours in a sample of 51 women who were currently working as prostitutes and also currently using opiates and/or stimulants. Most women reported regularly using condoms with clients but a substantial minority sometimes had unprotected sex with clients. There was no overall association between any of the drug use variables (including the use of crack cocaine) and the likelihood of unprotected sex. The use of drugs appears to have affected the sexual practices of different women in different ways: a substantial minority (just under a quarter of the sample) reported that for them, drug use did reduce the chances that they would use a condom. There was a link between willingness to have unprotected sex for more money and drinking larger amounts and drinking more often. The results also indicate that these women were exposed to a variety of health risks, including sharing injecting equipment and having unprotected sex with their regular partner who was often a current or former drug injector. A sub-sample (n = 34) completed a confidential questionnaire which showed that one-third had previously had at least one sexually transmitted disease and 15% of them had been infected during the previous year. These findings about rates of STD infection raise questions about the extent to which self-reported condom use by prostitutes can be used as an indicator of actual levels of infection risk.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Heterosexual anal intercourse, health risks and drug use: a review with special attention to drug users.

Research studying HIV risk-taking behaviour has tended to focus on specific populations who are characterized by particular behaviours. Such practices include the extent of unprotected anal intercourse among homosexual men, the sharing of injecting equipment among drug users and unprotected vaginal intercourse among female sex workers. There is often a failure among both researchers and practitioners to address specific risk behaviours outside of the defined risk group. Reviewed here are studies of heterosexual anal intercourse, with special attention to drug users and female sex workers. Among the general population, the reporting of heterosexual anal intercourse varies greatly across time and cultural groups. However, a body of recent research suggests that, despite some geographical differences, rates in most countries are relatively high. Many studies have also found that associated condom usage is low. Although unprotected anal intercourse is known to be an efficient method for the transmission of HIV and other viral infections, it has rarely been addressed outside cohorts of men who have sex with men. Of particular concern is the interaction of risk behaviours among drug users and women engaging in prostitution, many studies having found high levels of unprotected anal intercourse among these groups. Harm reduction interventions must address all the health risk behaviours their target groups are engaging in, if the challenge of reducing the transmission of HIV and other viral infections is to be met.

Journal Article↗
PubMed1995

Neuropsychological effects of subsequent exposure to phenylalanine in adolescents and young adults with early-treated phenylketonuria.

Severe mental handicap in phenylketonuria (PKU) can be prevented if dietary treatment is implemented at birth. Controversy remains about the optimum age for terminating treatment. A group of adolescents and young adults with PKU from the West of Scotland Register was identified which had received early treatment, been well-controlled on diet, ceased treatment at 10 years old and subsequently were hyperphenylalaninaemic for 3 years or more. They were given a battery of neuropsychological tests and their results were compared with those of on-diet subjects with PKU and normal controls. The findings generally supported the view that dietary cessation at age 10 is sufficient to prevent a substantial reduction of cognitive and motor ability, and that the central nervous system is probably mature enough to withstand the toxic effects of high blood phenylalanine by then. However, there were minor indications, in keeping with Welsh et al.'s hypothesis [M.C. Welsh, B.F. Pennington, S. Ozonoff, B. Rouse & E.R.B. McCabe (1990) Neuropsychology of early-treated phenylketonuria: specific executive function deficits.

Adolescent↗
PubMed1994

Prevalence of hepatitis C antibodies in clinical health-care workers.

Health-care workers are known to be at risk from occupational transmission of blood-borne viruses, including hepatitis C. There may be serious implications following infection with hepatitis C including possible transmission to patients. We determined the prevalence of hepatitis C virus (HCV) antibodies among health-care workers at risk of occupational contact with blood and body fluids and among source patients in reported blood-exposure incidents. Anonymised stored blood samples from health-care workers immunised against hepatitis B virus since 1991 (n = 1053) and blood samples from source patients in needlestick injuries (retrospective and prospective) since 1989 (n = 373) were analysed. 3 (0.28%) of the serum samples from health-care workers were found to be anti-HCV-positive. 17 (8.5%) of 200 source patients tested retrospectively between January 1989 and January 1992, and 24 (13.9%) of 173 source patients tested prospectively between January 1992 and June 1993 were anti-HCV-positive. During the second period, 15 (10.6%) of 142 source patients tested for human immunodeficiency virus (HIV) were positive and 7 (3.8%) of 184 source patients tested for hepatitis B surface antigen were positive. 6 of 24 (25%) HCV-infected patients were diagnosed only after the incident; for hepatitis B, 2 (33%) of patients were diagnosed after the incident, and for HIV all patients were previously diagnosed. The seroprevalence of HCV among these health-care workers is no higher than that reported in blood donors.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Multiple risks for HIV and hepatitis B infection among heroin users.

This study investigates the extent to which heroin users are exposed to multiple forms of infection risk. Structured interviews were administered to a prospective network sample of 408 heroin users. Subjects were contracted in south London in a wide range of social settings by specially recruited privileged access interviewers. Most heroin users (74.5%) had been exposed to more than one infection risk factor and more than half of the sample had been exposed to three or more risk factors. HIV serostatus was primarily related to men having sex with men. Hepatitis B seropositive status was primarily related to the number of years injecting drugs. At this stage of the HIV epidemic in London, HIV infection among heroin users may be related more to homosexual risk behaviour than drug risk factors. Heroin injectors were at greater risk of infection than heroin chasers both through their sexual behaviour as well as through their injecting practices. Heroin users who refused to give a saliva sample for analysis were found to be more likely to engage in several health risk behaviours than those who provided samples. This finding has important methodological implications for seroprevalence surveys. Other implications of the results for prevention programmes aimed at health risk behaviours of heroin users are also discussed.

Journal Article↗
PubMed1994

HIV seroprevalence in a London same-day testing clinic.

OBJECTIVES: To determine the prevalence of HIV infection among people attending a confidential, non-genitourinary medicine based testing clinic that provides HIV antibody test results on the day of consultation. METHODS: Retrospective analysis of data collected on 2635 individuals attending the Same-Day HIV Testing Clinic at the Royal Free Hospital, London between March 1992 and February 1993. RESULTS: A total of 1612 men and 1023 women were tested for HIV antibody. The primary risk for HIV infection was heterosexual (71.7%; 1889 out of 2635) and homosexual contact (24.5%; 646 out of 2635). Fifty-four individuals were given positive HIV test results (46 men, median age 34 years; eight women, median age 27 years). Overall HIV seroprevalence was 2.0% (95% confidence interval, 1.5-2.5). HIV seroprevalence was highest among homosexual men (6.5%; 41 out of 635) and injecting drug users (5.7%; four out of 70). The rates for heterosexual men and women were 0.2% (two out of 915) and 0.7% (seven out of 974), respectively. Of the 54 individuals who were HIV-antibody-positive, 44 were Centers for Disease Control and Prevention stage II/III, eight stage IV and one was tested at the time of seroconversion (stage I; data were not available for one patient). Of the total numbers attending this clinic 27% (702 out of 2635) had previously been tested and received a negative result. Of a total of 54 HIV-antibody-positive individuals, 40% (21) had previously received a negative test result. CONCLUSIONS: The data suggest that seroprevalence amongst homosexual men attending a designated HIV testing clinic in London is lower than that reported by genitourinary clinic based testing sites. The large number of repeat testers who subsequently became infected with HIV suggests that there is a population requiring specific targetting for HIV risk reduction.

AIDS Serodiagnosis↗
PubMed1994

Transitions in patterns of heroin administration: a study of heroin chasers and heroin injectors.

A community sample of 408 heroin users was interviewed about changes in their predominant route of heroin administration. Clear preferences for specific routes of drug administration were evident. Two predominant routes of administration were found: injection (54%) and 'chasing the dragon' (44%). More than a third of the sample had changed their predominant route of administration (a 'transition'). Most commonly, only one transition was reported, from chasing to injecting. However, transition to injection was not inevitable: the majority of 'chasers' had never moved to regular injecting despite often using at high doses for many years. Modelling suggests that many chasers give up heroin without moving to injecting. The results indicate, however, a continuing risk of switching from chasing to injecting for those who continued to use. Women were less likely to move from chasing to injecting. Some heroin users had made the transition from injection to chasing; 28 (16%) of the current chasers had previously been regular heroin injectors. This change in route is less well-known and to our knowledge has not been previously investigated. Multiple transitions in route were uncommon; predominant route of administration, once established appears robust. Harm reduction interventions directed towards changing the risk behaviours of heroin users should take account of the different routes of current administration and the potential for future transitions within continued drug use.

Administration, Inhalation↗
PubMed1994

Sexual behaviour and its relationship to drug-taking among prostitutes in south London.

The precise manner in which the use of different types of drugs is related to prostitution has not been adequately researched. This study investigates patterns of drug-taking and sexual behaviour among a group of women working as prostitutes in south London; it also looks at prostitution in which sex is offered in return for drugs, at the links between heroin, cocaine and alcohol use and sexual behaviour, and at the association between severity of dependence and sexual behaviour. All of the women in our sample (n = 51) were actively working as prostitutes. More than half of them had given sex for drugs, though this was a relatively infrequent occurrence. The majority of them were using heroin and many of them were moderately or severely dependent upon heroin. More than one-third had shared injecting equipment after it had already been used. Almost two-thirds reported that they only worked as a prostitute in order to fund their use of drugs (predominantly heroin), and that they would not continue working as a prostitute if they were not still using drugs. The more severely dependent upon heroin they were, the more likely they were to report these links between heroin use and prostitution. About half of the women in our sample said that they first started to work as a prostitute in order to pay for drugs. The women who began to use heroin prior to prostitution were more severely dependent on heroin and described themselves as being trapped in prostitution by the need to maintain a supply of heroin. Very few women regularly used cocaine in association with their prostitution. There are grounds for concern about the alcohol consumption of these women. About one-quarter of the women said that they used alcohol every day; some of them reported drinking at levels which greatly exceed recommended limits for women, and some were drinking at levels which were likely to be physically damaging.

Adult↗
PubMed1994

Sex differences in patterns of drug taking behaviour. A study at a London community drug team.

This study investigates sex differences in patterns of drug taking and related injecting and sexual behaviour among 355 patients attending a London community drug team. The majority of cases attending the service presented with heroin problems. Men were more likely to use heroin by injection and women were more likely to use heroin by inhaling/smoking ('chasing the dragon'); there was no sex difference in the overall incidence of needle sharing. The delay between first use of the problem drug and first presentation to services was the same for both men and women. Women were more likely to have a sexual partner who was a drug user and to be living with another user than men. This closer social attachment to other drug users was seen as presenting a high risk factor for women with regard to prognosis and treatment.

Adult↗