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Biomedical subjects

P Jones

Publications and source records attributed to P Jones.

At least 181 records · Page 10Linked to original sources
PubMed1997

Increased incidence of psychotic disorders in migrants from the Caribbean to the United Kingdom.

BACKGROUND: Several studies have replicated the finding of increased incidence of schizophrenia and related psychoses in first and second generation migrants from the Caribbean. The finding has remained consistent in studies employing different methods, but concern has been expressed about indirect methods of calculating the population at risk. This study aims to overcome these short-comings. METHOD: A further prospective study was undertaken in Nottingham assembling an inception cohort of psychotic patients (N = 168) presenting from a defined catchment area. The 1991 census, which includes codings for self-ascribed ethnic origin, was used to calculate the denominator, employing correction factors for potential under-enumeration. Case-ascertainment was based upon all service contacts and subjects had in-depth assessments including the SCAN. Collateral history was obtained from informants. RESULTS: Subjects born in the Caribbean, or who had one or both parents born in the Caribbean, had a greatly elevated risk (incidence ratios above 7) for all psychotic disorders and for ICD-10 (DCR)-defined F20 Schizophrenia. CONCLUSIONS: The size of the increase and the methodological safeguards employed support the validity of this now highly replicated finding. A personal or family history of migration from the Caribbean is a major risk factor for psychosis; the consistency of this finding justifies a systematic evaluation of potential aetiological factors. Any hypothesis derived from the evidence so far must explain: increased incidence in first and second generation migrants; increased risk for all psychoses (including affective psychoses); and an effect specifically associated with a migration history from the Caribbean to Northern Europe.

Adolescent↗
PubMed1997

A random controlled trial of two different vacuum extractor pumps: new foot pump and electric pump.

Worldwide the vacuum extractor is the instrument used most commonly for assisted vaginal delivery. Many institutions use electric pumps in preference to the original hand pump, considered by some to be inefficient (requiring an assistant). A new foot pump has been developed. In a controlled comparison with a standard electric pump, no differences in efficiency were found.

Journal Article↗
PubMed1997

Longitudinal sleep EEG power spectral analysis studies in adolescents with minor head injury.

Power spectral analysis (PSA) was used to evaluate the longitudinal overnight electroencephalographic (EEG) sleep recordings of eight subjects, between the ages of 15 and 19 years, who had sustained a minor head injury (MHI). Recordings occurred within 72 h, 6 weeks, and 12 weeks following MHI. A conditioning night preceded the first study night during which EEG electrodes were in place and subjects slept at least 7.5 h with a mean sleep efficiency of 91%. PSA was performed on four channels of EEG data recorded from fronto-temporal (F3-T3, F4-T4), and temporal (T3-T5, T4-T6) electrodes. The three waveforms associated with sleep, Delta, Theta, and Alpha-1 were all significantly elevated within 72 h post-MHI. Over time all wave forms decreased in mean log power. Theta in rapid eye movement (REM) sleep Cycle 1 decreased significantly within 6 weeks postinjury. The greatest number of significant changes, over the 12-week period were recorded during the non-REM (NREM) sleep. Changes included (1) significant decreases in mean log power of Theta and Alpha-1 in Cycle 1 from fronto-temporal leads; (2) significant decreases in Delta, Theta, and Alpha-1 in Cycle 2 from fronto-temporal leads, and (3) significant decreases in Delta and Theta for consistency during Cycle 2 from temporal leads. The intrusion of Theta into the first REM cycle within 6 weeks and its subsequent decrease within 6 weeks suggested the initiation of recovery toward baseline values. This was followed by decreased levels of Theta power during NREM Cycles 1 and 2, and Delta power in Cycle 2, both of which approached their lowest levels within 12 wks. The decrease in Alpha-1 power occurred last. Alpha-1 remained elevated through both Cycles 1 and 2 of the 6th week and then showed a precipitous decrease between the sixth and twelfth week. These findings suggested that following MHI, the brain has a specific sequence of recovery as illustrated by Delta, Theta, and Alpha-1 powers requiring different time frames to reach their lowest levels.

Adolescent↗
PubMed1997

Association between central nervous system infections during childhood and adult onset schizophrenia and other psychoses: a 28-year follow-up.

BACKGROUND: Maternal exposure to influenza epidemics during pregnancy may increase the risk of schizophrenia in the offspring. We investigated the association between central nervous system (CNS) infections defined prospectively up to the age of 14, and later onset of schizophrenia and other psychoses in the 1966 birth cohort in Northern Finland, which covers 96% of all births in the area during that year. METHODS: Data regarding CNS infections were collected 1966-1980. Registered diagnoses of psychoses in 1982-1993 were validated on DSM-III-R criteria. RESULTS: Out of 11,017 subjects, 145 had suffered a CNS infection during childhood, 102 of them a viral infection, 76 had DSM-III-R schizophrenia and 53 some other psychosis. Four cases of schizophrenia had suffered viral CNS infection and two cases of other psychosis bacterial infection. When neurological abnormalities and father's social class were adjusted odds ratio (OR) of schizophrenia after viral CNS infection was 4.8 (95% confidence intervals [CI] : 1.6-14.0); the other significant risk factors being intelligence quotient (IQ) < 85, perinatal brain damage and male sex but not epilepsy. Similarly adjusted OR of other psychoses was 6.9 (95% CI: 1.4-32.8) after bacterial CNS infection; the other significant risk factors being IQ < 85 and severe hearing defect. Two of the live viral infections were caused by Coxsackie B5 during an epidemic in which 16 neonates were infected together. CONCLUSIONS: Central nervous system infections during childhood clearly carried an increased risk of adult onset schizophrenia or other psychoses, viral infections being important for schizophrenia, particularly Coxsackie B5 during the newborn period.

Adolescent↗
PubMed1997

Depressive symptoms and self-concept in young people with spina bifida.

Examined self-reported depressive symptoms in 72 young people with spina bifida, ages 9 to 18:11, and matched able-bodied comparison subjects, using the Dimensions of Depression Profile for Children and Adolescents (Harter & Nowakowski, 1987). Independent variables included gender, self-perceptions (including physical appearance), and perceived social support. Young people with spina bifida were at greater risk of depressive mood, low self-worth, and suicidal ideation. Girls, independent of disability, were at greater risk of depressive mood, low self-worth, and self-blame. Multiple regression analyses suggest that global self-worth serves as a mediating variable for the effect of physical appearance self-concept on depressed mood (particularly in young people with spina bifida), and that perceived parental social support has a direct effect on depressed mood (particularly in girls).

Adolescent↗
PubMed1997

The early origins of schizophrenia.

Large population-based studies indicate that children who will as adults develop the clinical syndrome of schizophrenia are different from their peers in terms of the acquisition of a range of neurological, cognitive and behavioural characteristics. These studies are also identifying possible causal factors which might operate early in life and so be responsible for a longitudinal aspect of the disorder. Studies of the brain yield results consistent with the multi-system nature of the clinical syndrome of schizophrenia in adult life, and with the notion of a longitudinal or developmental phenotype, of which the adult syndrome is but one aspect. Work in these areas is reviewed with special reference to national birth cohorts from Britain and Finland.

Adolescent↗
PubMed1997

Liposomal amphotericin B (AmBisome) compared with amphotericin B both followed by oral fluconazole in the treatment of AIDS-associated cryptococcal meningitis.

OBJECTIVE: Amphotericin B deoxycholate initial therapy and fluconazole maintenance therapy is the treatment of choice for AIDS-associated cryptococcal meningitis. However, the administration of amphotericin B is associated with considerable toxicity. A potential strategy for reducing the toxicity and increasing the therapeutic index of amphotericin B is the use of lipid formulations of this drug. DESIGN AND METHODS: HIV-infected patients with cryptococcal meningitis were randomized to treatment with either liposomal amphotericin B (AmBisome) 4 mg/kg daily or standard amphotericin B 0.7 mg/kg daily for 3 weeks, each followed by fluconazole 400 mg daily for 7 weeks. During the first 3 weeks, clinical efficacy was assessed daily. Mycological response was primarily evaluated by cerebrospinal fluid (CSF) cultures at days 7, 14, 21 and 70. RESULTS: Of the 28 evaluable patients, 15 were assigned to receive AmBisome and 13 to receive amphotericin B. Baseline characteristics were comparable. The time to and the rate of clinical response were the same in both arms. AmBisome therapy resulted in a CSF culture conversion within 7 days in six out of 15 patients versus one out of 12 amphotericin B-treated patients (P = 0.09), within 14 days in 10 out of 15 AmBisome patients versus one out of nine amphotericin B patients (P = 0.01), and within 21 days in 11 out of 15 AmBisome patients versus three out of eight amphotericin B patients (P = 0.19). When Kaplan-Meier estimates were used to compare time to CSF culture conversion, AmBisome was more effective (P < 0.05; median time between 7 and 14 days for AmBisome versus > 21 days for amphotericin B). AmBisome was significantly less nephrotoxic. CONCLUSIONS: A 3-week course of 4 mg/kg AmBisome resulted in a significantly earlier CSF culture conversion than 0.7 mg/kg amphotericin B, had equal clinical efficacy and was significantly less nephrotoxic when used for the treatment of primary episodes of AIDS-associated cryptococcal meningitis.

AIDS-Related Opportunistic Infections↗
PubMed1997

Trafficking of amino acids between neurons and glia in vivo. Effects of inhibition of glial metabolism by fluoroacetate.

Glial-neuronal interchange of amino acids was studied by 13C nuclear magnetic resonance spectroscopy of brain extracts from fluoroacetate-treated mice that received [1,2-(13)C]acetate and [1-(13)C]glucose simultaneously. [13C]Acetate was found to be a specific marker for glial metabolism even with the large doses necessary for nuclear magnetic resonance spectroscopy. Fluoroacetate, 100 mg/kg, blocked the glial, but not the neuronal tricarboxylic acid cycles as seen from the 13C labeling of glutamine, glutamate, and gamma-aminobutyric acid. Glutamine, but not citrate, was the only glial metabolite that could account for the transfer of 13C from glia to neurons. Massive glial uptake of transmitter glutamate was indicated by the labeling of glutamine from [1-(13)C]glucose in fluoroacetate-treated mice. The C-3/C-4 enrichment ratio, which indicates the degree of cycling of label, was higher in glutamine than in glutamate in the presence of fluoroacetate, suggesting that transmitter glutamate (which was converted to glutamine after release) is associated with a tricarboxylic acid cycle that turns more rapidly than the overall cerebral tricarboxylic acid cycle.

Acetates↗
PubMed1997

Tardive dyskinesia: who is at risk?

Tardive dyskinesia (TD) has been associated with female gender, affective symptoms and good outcome, but also with negative symptoms, cognitive deterioration and deteriorating illness course. Furthermore, antipsychotic medication is thought to be an important risk factor, yet abnormal movements also occur in patients who have never received such medication. We followed 166 subjects with recent onset of psychotic illness and brief previous exposure to antipsychotic medication. Information on 17 previously reported risk factors was available for 125 patients at baseline and, for factors that vary over time, again at follow-up 4 years later (median, 50 months; interquartile range, 29-70). Movement disorder was assessed at follow-up using the Abnormal Involuntary Movement Scale (AIMS). Six noninteracting variables were independently associated with the 4-year risk of TD: male sex (OR, 2.5; 95% CI, 1.1-5.0), age (OR over quartiles at baseline, 1.6; 95% CI, 1.1-2.2), lack of insight at baseline (OR over four categories, 2.0; 95% CI, 1.2-3.2), time on antipsychotics during the follow-up period (OR over quartiles, 2.3; 95% CI, 1.5-3.4), an increase in negative symptoms during the follow-up period (OR over quartiles, 1.7; 95% CI, 1.2-2.5), and alcohol/drug misuse at follow-up (OR, 3.0; 95% CI, 1.3-7.4). The presence of individual risk factors was found to be of little use as a screening test for subsequent clinically relevant TD. Given the absence of a risk factor, however, the probability that an individual would not develop TD was high. These results suggest that two discrete effects may operate to increase the risk of TD, namely an exogenous factor (medication, drugs), and an illness-related factor, the highest risk being conferred by deteriorating illness course in male patients.

Adult↗
PubMed1997

Aspirin-induced post-gingivectomy haemorrhage: a timely reminder.

A case report is described of significant aspirin-induced haemorrhage following a gingivectory procedure in an organ transplant patient. Aspirin-induced platelet impairment secondary to low-dose aspirin was implicated as the cause of the haemorrhage. Haemostasis was eventually achieved after platelet transfusion. The case illustrates the problems that can arise when carrying out gingival surgery on patients medicated with low-dose aspirin.

Adult↗
PubMed1997

Perioperative collapse: prevalence of latex allergy in patients sensitive to anaesthetic agents.

The evidence in the literature suggests that the prevalence of latex allergy in the general population is approximately 1%. With increasing awareness of transmission of HIV and other infections such as hepatitis B, the use of latex gloves and condoms has escalated in recent years. As cheaper latex gloves of variable and doubtful quality flood the market, health care workers and patients are being increasingly sensitized by these latex products. A retrospective study investigated the prevalence of latex allergy in a cohort of 26 patients who suffered perioperative anaphylactoid reactions. 84% of these patients were hypersensitive to at least 1 anaesthetic-related agent. 7.7% were also allergic to latex (p = 0.028). Atopy is a strong predisposing factor (p = 0.006). An accurate preoperative history of atopy and past reactions to latex will identify most at-risk patients. Prick test and RAST to latex will confirm the latex allergy. Anaesthetists, surgeons, allergists and other health practitioners should be aware of this problem.

Adolescent↗
PubMed1997

Premorbid social functioning in schizophrenia and bipolar disorder: similarities and differences.

OBJECTIVE: This research examined social functioning in childhood and adolescence among patients with schizophrenia and patients with bipolar disorder compared with healthy subjects and investigated the relation between premorbid adjustment and risk factors for psychosis. METHOD: Maternal recall was used to assess the premorbid adjustment of patients with schizophrenia (N = 70) and patients with bipolar disorder (N = 28) recruited from a survey of consecutive hospital admissions for psychosis and of healthy comparison subjects (N = 100) drawn from the same catchment area. RESULTS: The patients with schizophrenia had significantly poorer premorbid adjustment in childhood and adolescence than the comparison subjects and were impaired in both sociability and school adjustment. The patients with bipolar disorder exhibited poorer social impairment in adolescence than the comparison subjects, though to a lesser degree than the schizophrenic subjects, but functioned well at school. There were significant linear trends in the risk of psychosis with worsening premorbid functioning, which was most marked in the schizophrenic group, and a specific linear relation between low birth weight and poor premorbid adjustment among the schizophrenic patients. CONCLUSIONS: Impaired premorbid social functioning is not specific to schizophrenia and is seen also in bipolar disorder. The data support the view that poor premorbid social adjustment is one manifestation of vulnerability to adult psychotic disorders. These results are consistent with other findings pointing to early developmental deficits in patients who subsequently develop psychosis.

Adolescent↗
PubMed1997

Risk factors for ischaemic heart disease in patients with dermatitis herpetiformis.

For reasons that are unclear, patients with dermatitis herpetiformis (DH) have a lower than expected mortality rate from ischaemic heart disease. We have compared risk factors for ischaemic heart disease (lipids, fibrinogen levels, smoking history and social class) in 29 DH patients and 57 controls matched for age and sex. Patients with DH had significantly lower cholesterol, triglycerides, apolipoprotein B and fibrinogen and higher HDL2; they also smoked less and were of higher social class. The mechanisms underlying these observations merit further investigation. Intestinal abnormalities or gluten-free diet may account for differences in lipid fractions, and the immunomodulatory properties of cigarette smoke may protect against the development of DH.

Aged↗
PubMed1997

Psychopathological syndromes and familial morbid risk of psychosis.

BACKGROUND: Familial liability in the functional psychoses had traditionally been examined by comparing mutually exclusive diagnostic categories. This study examines overlapping psychopathological dimensions in relation to familial morbid risk of psychosis. METHOD: We tested for associations between seven factor-analysis derived psychopathological dimensions and familial morbid risk of psychosis, in a sample of 150 patients with recent-onset functional psychosis and 548 of their first-degree relatives. RESULTS: A syndrome characterised by affective blunting and insidious and early onset of illness, non-specifically predicted psychosis in the first-degree relatives, whereas a manic syndrome specifically predicted affective psychosis in the relatives. No other main effects were observed, but there were interactions with proband diagnosis: a syndrome characterised by bizarre behaviour, inappropriate affect, catatonia and poor rapport predicted psychosis in relatives of schizophrenic probands, and a syndrome of depressive: symptoms predicted psychosis in relatives of schizoaffective probands. Positive symptoms were not associated with illness in the relatives. CONCLUSIONS: Genetic effects in the functional psychoses may comprise non-specific components that canalise a general, early-onset, affective blunting phenotype and several other, more specific, influences on phenotypic variation.

Adult↗
PubMed1997

CT scanning of the paranasal sinuses--the effect of reducing mAs.

High quality CT scans are required prior to fibreoptic endoscopic sinus surgery (FESS) surgery and in many institutions such scans are performed using a high mAs technique. Consequently, the investigation imparts a radiation dose to the patient and in particular to the eye. Such a radiation dose is a possible source of morbidity. We believe that the mAs, and consequently the radiation dose, can be considerably reduced without affecting scan quality. The present study compares the quality of sinus CT scans performed at two mAs values, 40 and 60. Scan quality was assessed in terms of the ability to visualize clearly important anatomical structures and in terms of overall perceived quality. We show that mAs values as low as 40 can be used without adversely affecting the diagnostic quality of the examination.

Humans↗
PubMed1997

Practical guidelines for developing a hospital-based wound and ostomy clinic.

Multidisciplinary teams save time and money while improving quality of patient care. Hospital-based wound/ostomy clinics provide patients with holistic, one-stop, expert care with access to a variety of diagnostic and treatment modalities. The authors discuss how to assemble all the ingredients for a successful multidisciplinary hospital-based clinic, how to make it work, and how to measure its cost-effectiveness for patient, hospital, community and nation. The original model clinic established in Costa Rica using these methods was so successful at providing efficient, high quality, cost-effective care that it has been adopted in 17 different locations there, and similar clinics are being developed in other countries. This model is applicable to industrialized and developing countries. By focusing hospital resources on evidence-based wound/ostomy care, it has the potential to revolutionize wound and ostomy care around the world.

Cost-Benefit Analysis↗