A neurophysiological study of somatization disorder.
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Adult↗
Biomedical subjects
P Kelly
Publications and source records attributed to P Kelly.
HIV seropositivity and tuberculosis in a rural Malawi hospital.
This study was undertaken to determine the extent to which human immunodeficiency virus (HIV) infection has increased hospital admissions for tuberculosis (TB) in a rural population of southern Malawi. The notes and chest X-rays of TB patients admitted to Malamulo hospital in 1983 and 1984, before the recognition of acquired immune deficiency syndrome (AIDS) in Malawi, were compared with those of patients admitted in 1987 and 1988. We found a 160% increase in TB admissions between the 2 periods. Extrapulmonary TB, especially pleural TB, was much commoner in 1987-1988 and occurred in a younger age group. HIV seroreactivity was measured in a third group of 152 tuberculosis patients admitted during 1988-1989. HIV seropositivity was found in 52% of all tuberculosis admissions and in 75% of those with extrapulmonary disease. There was no difference in clinical response to TB therapy between the HIV seropositive patients and those who were seronegative. Extrapulmonary TB should be considered in all HIV seropositive patients, especially in areas where the prevalence of TB is high. Health personnel involved in TB programmes where HIV and TB infections are prevalent should plan for a large increase in the TB case load secondary to the HIV pandemic.
Adult↗
Cutaneous reactions to thiacetazone in Zambia--implications for tuberculosis treatment strategies.
Tuberculosis in patients infected with human immunodeficiency virus (HIV) is a growing threat to public health in Africa. Thiacetazone, one of the continent's most widely used antituberculous agents, may lead to severe cutaneous reactions in the HIV infected individual. We describe the impact of this reaction on the tuberculosis (TB) control programme of a district hospital in Zambia in 1990, and examine the cost implications of changing the standard treatment regime. We carried out a retrospective survey of records of all patients beginning TB treatment in 1990, together with HIV test results and the cost of all treatments given. From this we derived estimates of costs of different regimes which are and could be used in TB control in Zambia. Severe reactions occurred in 18.7% of all HIV seropositive patients receiving thiacetazone, fatally so in 1.2% (odds ratio 16.6). The greatest part of the cost of the current regime is that attributable to the inpatient stay; we estimated that 29.4% of patients would be unable to receive drugs as out-patients but, even allowing for this, rifampicin-based regimes given to outpatients where possible would not cost more than the current strategy. We conclude that ethical and economic considerations support a change to rifampicin-based regimes in areas of Africa where HIV seroprevalence is high.
AIDS-Related Opportunistic Infections↗
Contrasting incidence of Clostridium difficile and other enteropathogens in AIDS patients in London and Lusaka.
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AIDS-Related Opportunistic Infections↗
A method for diagnosis of microsporidiosis adapted for use in developing countries.
Microsporidiosis in AIDS patients has emerged as an important cause of morbidity, but diagnosis requires special stains, equipment and expertise. Here we describe a modification to an existing staining technique to allow more rapid preparation, without additional equipment, facilitating research in the tropics into these important pathogens.
Azo Compounds↗
Expression of apoptosis-associated genes by human dermal scar fibroblasts.
The purpose of this study was to determine if aberrant apoptosis plays a role in pathologic wound healing as manifested by hypertrophic scarring and keloid formation. Apoptosis has recently been found to participate in the transition between granulation tissue and the development of definitive scar. The question that remains to be answered is what stimuli initiate apoptosis during wound healing. Hitherto, regulatory factors and pathways involved have been largely undefined. We investigated heterogeneity among fibroblasts derived from normal skin and keloid scar, by examining apoptotic profiles and pathways for these cells. Quantitative analysis of apoptotic cells using an Annexin-V-FITC binding assay showed that normal skin fibroblast cultures were found to have a two-fold higher percentage of apoptotic cells than did keloid fibroblast cultures. To study apoptotic pathways and related death-associated genes, a ribonuclease protection assay was performed for fibroblasts exposed to anti-Fas antibody and tumor necrosis factor-alpha to activate the Fas/TNF receptor apoptotic pathway. Compared with normal skin fibroblasts, keloid fibroblasts exhibited decreased expression of apoptosis-associated genes.
Adult↗
Metabolism of tetrahydrocannabinol in frequent and infrequent marijuana users.
delta 9-tetrahydrocannabinol (THC), 11-nor-9-carboxy-delta 9- tetrahydrocannabinol (THC-COOH), and its O-ester glucuronide were measured in plasma by GC/MS and in urine by GC/MS and enzyme immunoassay after frequent and infrequent marijuana users were given 5 mg THC intravenously. Plasma THC concentrations were detectable 4-5 h after infusion using solid-phase columns for drug extraction and gas chromatography/mass spectrometry (GC/MS) for detection and quantification. THC-COOH and its O-ester glucuronide were analyzed for 12 days. Concentrations were higher in the plasma and urine of frequent marijuana users. The ratio of THC-COOH to its O-ester glucuronide in plasma was greater than 2 in both frequent and infrequent users 2 to 30 min postinfusion. Ratios for the subsequent 12 days were less than 2. A ratio of less than 1 for total THC-COOH/THC occurred only before 45 min for both frequent and infrequent users. Physiological, psychological, and pharmacokinetic data revealed few differences between frequent and infrequent marijuana users.
Adult↗
Differentiating roles in quality assurance.
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Humans↗
Declining prevalence of cervicovaginal human papillomavirus infection with age is independent of other risk factors.
BACKGROUND AND OBJECTIVES: Human papillomavirus (HPV) infection of the female genital tract is the most common sexually transmitted disease. Although the prevalence of HPV in women without detectable cervical disease has been shown to decline with increasing age, the relationship to sexual behavior has not been investigated. GOAL: To identify risk factors for, and associated with the age-dependent decline in, genital HPV infection in women. STUDY DESIGN: The prevalence of HPV was determined in a cohort of 439 sexually active inner-city women between the ages of 18 and 50 years recruited in Brooklyn, New York. Cervicovaginal cells were collected by lavage, and HPV was detected by low-stringent Southern blot hybridization. RESULTS: The prevalence of HPV infection ranged from 36% in women younger than 25 years of age to 2.8% in women 45 years or older. Logistic regression analysis identified an increased risk for cervical HPV infection to be independently associated with number of sex partners in the past year (odds ratio [OR], 1.04 per yearly increase in age; 95% confidence interval [CI], 1.00 to 1.08), younger age (OR, 0.92 per year increase in age; 95% CI, 0.88 to 0.95), and not living with partner (OR, 2.28; 95% CI, 1.40 to 4.22). CONCLUSIONS: The lower prevalence of HPV infection in older women compared to younger women was found to be independent of sexual behavior. These results suggest that a biologic effect, such as HPV immunity acquired over time and with multiple exposures, may mediate the inverse relationship between age and HPV prevalence.
Adolescent↗
Comprehensive health assessment for newly arrived refugee children in Australia.
Providing appropriate and responsive care to refugees from diverse backgrounds and with unique health needs is challenging. Refugee children may present with a wide range of conditions, which may be unfamiliar to health professionals in developed countries. Additionally, refugees may experience unfamiliarity with the Australian health system and distrust of authority figures and/or medical practitioners. This article provides an overview of the priority areas in health and health management for paediatric refugee patients for paediatricians as well as other relevant health care providers caring for this group. Specific issues covered include general health assessment, infectious diseases, immunization, growth and nutrition, oral health, development and disability, mental health and child protection. Comprehensive health assessment can assist in identifying children at risk of poor health and to provide them with timely and effective care, advocacy and appropriate referral.
Australia↗
An issue of access: delivering equitable health care for newly arrived refugee children in Australia.
Newly arrived refugees and asylum seekers are faced with many difficulties in accessing effective health care when settling in Australia. Cultural, language and financial constraints, lack of awareness of available services, and lack of health provider understanding of the complex health concerns of refugees can all contribute to limiting access to health care. Understanding the complexities of a new health care system under these circumstances and finding a regular health provider may be difficult. In some cases there may be a fundamental distrust of government services. The different levels of health entitlements by visa category and (for some) detention on arrival in Australia may further complicate the provision and use of health services for providers and patients. Children are particularly at risk of suboptimal health care due to the impact of these factors combined with the effect of resettlement stresses on parents' ability to care for their children. Unaccompanied and separated children, and those in detention experience additional challenges in accessing care. This article aims to increase awareness among health professionals caring for refugee children of the challenges faced by this group in accessing and receiving effective health care in Australia. Particular consideration is given to the issues of equity, rights of asylum seekers, communication and cultural sensitivities in health care provision, and addressing barriers to health care. The aim of the paper is to alert practitioners to the complex issues surrounding the delivery of health care to refugee children and provide realistic recommendations to guide practice.
Australia↗
Extreme elevation of maternal serum alpha-fetoprotein associated with mosaic trisomy 8 in a liveborn.
Constitutional mosaic trisomy 8 has been associated with syndromic dysmorphology, corneal opacities, leukemias, and trophoblastic disease. However, abnormal maternal serum alpha-fetoprotein (MSAFP) has not been reported in association with mosaic trisomy 8. Our case first presented for evaluation of an extremely elevated MSAFP with mild elevation of MShCG in an otherwise normal pregnancy: MSAFP 13.89 MoM, MShCG 3.57 MoM, and MSuE3 1.04 MoM. Fetal dysmorphism was limited to bilateral pyelectasis and a prominent third ventricle. Spontaneous labor at 38 weeks resulted in the birth of a 3,570-gram AGA male with APGARs 7(1)/8(5). The neonate had facial asymmetry, 5th finger clinodactyly, 2-3 toe syndactyly, undescended testicle, abnormal prepuce, and mild pyelectasis. CT scan revealed hypoplasia of the corpus callosum, while echocardiography demonstrated bicuspid aortic valve, and the neonatal karyotype (blood) returned 46,XY/47,XY+8. Evaluation at 3 months revealed more prominent facial asymmetry, plagiocephaly, plantar creases, descent of the testis, and mild developmental delay. Review of the literature does not include any previously reported maternal serum alpha-fetoprotein aberrations in mosaic trisomy 8.
Adult↗
Organizing health care for families affected by HIV.
HIV models of care focus primarily on the needs of individuals and may not successfully meet the needs of the whole family. Family-centred care represents an approach to care and management that focuses on the needs of the family as a whole rather than solely on the needs of the child or the needs generated by his/her illness. Family-centred care requires a multidisciplinary approach. A barrier is the desire of individual professional groups to maintain control over their own area of expertise.
Family↗
Bringing support home for families of children with cancer.
The Macmillan paediatric service at Southampton has grown in the context of an established service and in response to the perceived needs of families. In the environment of an internal market, care provided must be more explicit to inform decision making regarding its continuation.
Adolescent↗
Patient-physician communication: a selective literature review.
No longer are patients willing to accept the dictum of physicians as all-knowing experts solely capable of determining a patient's future. In fact, the "patient" label itself is often superseded by the concept of healthcare consumers, implying greater equality and patient participation in the patient-physician relationship.
Canada↗
Management training in the central districts--a modular structure.
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Administrative Personnel↗