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Biomedical subjects

P Salmon

Publications and source records attributed to P Salmon.

At least 55 records · Page 3Linked to original sources
PubMed1998

Study I: development and criterion validity of the Children's Interview for Psychiatric Syndromes (ChIPS).

OBJECTIVE: To test the psychometric properties of the Children's Interview for Psychiatric Syndromes (ChIPS), a second-generation structured diagnostic interview designed to improve on the methodology provided by first-generation structured interviews, which have increased diagnostic reliability over unstructured clinical interviews. METHOD: Forty-two children hospitalized on a children's inpatient unit were administered the ChIPS and the Diagnostic Interview for Children and Adolescents (DICA). The level of agreement regarding syndrome presence or absence of 15 diagnoses according to the two instruments was assessed using a standard kappa coefficient or a rare kappa coefficient and percentage agreement. RESULTS: Agreement between the two instruments was significant (p < 0.05) for 13 of 14 diagnoses for which either kappa coefficient could be calculated. Percentage agreement was 98% and 100% for the remaining two diagnoses. ChIPS and DICA results also were compared with a psychiatrist's diagnoses. Sensitivity was 80% for ChIPS and 61% for DICA. Specificity was 78% for ChIPS and 87% for DICA. CONCLUSION: ChIPS is proposed as a valid measure of child psychopathology that offers advantages over existing interviews.

Child↗
PubMed1998

Study II: concurrent validity of the DSM-III-R Children's Interview for Psychiatric Syndromes (ChIPS).

OBJECTIVE: To test the concurrent validity of the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., revised) (DSM-III-R) revised Children's Interview for Psychiatric Syndromes (ChIPS). METHOD: In this study, the DSM-III-R revised ChIPS, the DSM-III-R revised Diagnostic Interview for Children and Adolescents (DICA-R-C), and clinicians' diagnoses were compared in 71 inpatients and outpatients 6 to 13 years of age using a standard kappa coefficient or a rare kappa coefficient and percentage agreement. RESULTS: High levels of agreement were found between the two interviews on all 14 syndromes analyzed (p < 0.05). ChIPS and DICA also had high levels of agreement with clinicians' diagnoses. When DSM-III-R revised ChIPS and DICA-R-C results were discrepant, ChIPS results were somewhat more likely than DICA-R-C results (48 % versus 38%) to agree with the clinician's diagnoses. CONCLUSION: ChIPS appears to be a valid assessment for screening children in inpatient and outpatient mental health facilities. It has the added benefit of being brief, with average administration time of 46 minutes for an inpatient sample and 36 minutes for an outpatient sample.

Adolescent↗
PubMed1998

Study III: development and concurrent validity of the Children's Interview for Psychiatric Syndromes--parent version (P-ChIPS).

OBJECTIVE: To assess concurrent validity for the newly developed parent version of the Children's Interview for Psychiatric Syndromes (P-ChIPS). METHOD: ChIPS and P-ChIPS were administered to 36 children 6 to 13 years of age and their parents. P-ChIPS results were compared with clinicians' diagnoses for 21 of those children. Either a standard or rare kappa coefficient and percentage agreement were used to assess concordance. Questions on P-ChIPS have a one-to-one correspondence with questions on the ChIPS, with the only change being from first to third person (e.g. "Have you ever . ." is replaced by "Has your child ever . . ."). RESULTS: There were moderate levels of agreement between the parent and child versions of the instrument, consistent with other reports of parent and child concordance on structured interviews in the literature. Likewise, there were moderate levels of agreement between the parent interview and clinician diagnoses, again consistent with other reports of parent and clinician concordance in the literature. Sensitivity averaged 87% across diagnostic categories, and average specificity was 76%. CONCLUSION: P-ChIPS has adequate psychometric properties for use in clinical settings.

Adolescent↗
PubMed1998

A continuum of neutrophilic disease occurring in a patient with ulcerative colitis.

A case of Sweet's syndrome (acute febrile neutrophilic dermatosis) occurring concurrently with bullous pyoderma gangrenosum is reported to emphasize the close relationship between these two disorders. Atypical pyoderma gangrenosum and Sweet's syndrome have been described as occurring simultaneously in haematological dyscrasias but not, to our knowledge, in ulcerative colitis. It has been proposed that pyoderma gangrenosum, Sweet's syndrome, erythema elevatum diutinum and subcorneal pustular dermatosis may represent manifestations along a continuum of neutrophilic dermatoses.

Biopsy, Needle↗
PubMed1998

General practice patients' beliefs about their symptoms.

BACKGROUND: Patients' beliefs about symptoms are major influences on consultation and its consequences. However, little information is available about the beliefs of patients when they consult their general practitioner (GP). AIM: To describe and quantify the range of beliefs of patients about their symptoms before consultation, and to test the hypothesis that patients who attribute symptoms to stress or lifestyle would expect less benefit than others from physical medicine but more from lifestyle change and emotional support. METHOD: Interviews with 100 patients attending one of two general practices were used to form a questionnaire, which was completed by 406 patients attending one of three general practices in contrasting areas of Greater London. This measured the frequency of specific beliefs about the causes of their symptoms and about effective forms of help. Patients were seen before their consultation. RESULTS: The most common aetiological beliefs concerned stress and lifestyle. In general, the mechanisms underlying symptoms were thought to be disturbances in bodily functioning rather than pathological processes. The most valued form of help was explanation and discussion of symptoms. Nevertheless, about half the patients expected benefit from medication and only slightly fewer from hospital investigation or treatment. Patients who attributed symptoms to stress or lifestyle were no less likely to expect help from medication or specialist referral, but they were more likely to see benefit in explanation and counselling or lifestyle change. CONCLUSIONS: These findings suggest hypotheses for future research into the effects that patients' attributions of their symptoms to stress and lifestyle have on their health care demands, emphasize the importance of routinely assessing patients' beliefs on consulting the GP, and provide information that can help to direct this assessment in the individual case.

Adolescent↗
PubMed1997

A theory of postoperative fatigue: an interaction of biological, psychological, and social processes.

The concept of postoperative fatigue has been developed to explain the feelings of malaise and the reduction in activity during the convalescent period that follows surgery in humans. Fatigue has been assumed to reflect the degree of surgical trauma and to be a consequence of muscle weakness caused by physiological sequelae of the trauma. The evidence is inconsistent with this reductionist view. Instead we propose a theory that postoperative fatigue is based on an emotional and motivational change that has the function of ensuring inactivity so as to preserve homeostasis in vital systems in response to injury while preserving the physical capacity to respond to new challenge. This response, triggered by the patient's perception of the surgical stimulus, is prolonged by the influence of staff and patient expectations, which, in turn, reflect cultural beliefs in the necessity of convalescence. This theory can be tested by manipulation of clinical practice at pharmacological and psychological levels.

Emotions↗
PubMed1997

Psychological stress does not affect plasma catecholamines in subjects with cardiovascular disorder.

Whereas the effects of cardiac transplantation on the catecholamine response to physical exercise have been studied previously, the impact on psychological stress is unknown. Here, the arterial catecholamine response to the Stroop test of patients with an orthotopic heart transplant (OHT) was compared with that in subjects who had received a coronary artery bypass graft (CABG) or who were in heart failure and destined for a heart transplant (HF). Subjects were tested whilst sitting and their usual drug therapy was maintained. The Stroop test increased subjects' subjective tension but did not affect arterial concentrations of adrenaline or noradrenaline in any group of subjects. Also, the concentration of both catecholamines was significantly higher in OHT and CABG subjects than in the HF group, but their relative concentration was unaffected by cardiovascular status or stress. It is concluded that the absolute concentrations of arterial catecholamines, but not their relative concentrations, depend on clinical status. Moreover, under these test conditions, subjects with a history of cardiovascular disorder do not show the normal catecholamine response to psychological stress.

Adolescent↗
PubMed1997

A theory of postoperative fatigue.

The concept of fatigue has entered medicine from other disciplines in which the term refers to weakening of a material by demands put upon it. Its application to the behavioural and subjective changes that characterize postoperative convalescence has led to the assumption that these changes reflect the physiological and metabolic consequences of surgery. Because evidence does not support this view, we outline a new theory in which postoperative fatigue is the product of physiological, psychological and cultural factors. This theory leads to novel predictions that can be tested in future clinical research. Of particular interest will be the evaluation of systematic attempts to change patient and staff expectations about postoperative convalescence.

Attitude of Health Personnel↗
PubMed1996

An activated form of Notch influences the choice between CD4 and CD8 T cell lineages.

Notch is a transmembrane receptor that controls cell fate decisions in Drosophila and whose role in mammalian cell fate decisions is beginning to be explored. We are investigating the role of Notch in a well-studied mammalian cell fate decision: the choice between the CD8 and CD4 T cell lineages. Here we report that expression of an activated form of Notch1 in developing T cells of the mouse leads to both an increase in CD8 lineage T cells and a decrease in CD4 lineage T cells. Expression of activated Notch permits the development of mature CD8 lineage thymocytes even in the absence of class I major histocompatability complex (MHC) proteins, ligands that are normally required for the development of these cells. However, activated Notch is not sufficient to promote CD8 cell development when both class I and class II MHC are absent. These results implicate Notch as a participant in the CD4 versus CD8 lineage decision.

Animals↗
PubMed1996

The cytoplasmic domain of CD4 promotes the development of CD4 lineage T cells.

Thymocytes must bind major histocompatibility complex (MHC) proteins on thymic epithelial cells in order to mature into either CD8+ cytotoxic T cells or CD4+ helper T cells. Thymic precursors express both CD8 and CD4, and it has been suggested that the intracellular signals generated by CD8 or CD4 binding to class I or II MHC, respectively, might influence the fate of uncommitted cells. Here we test the notion that intracellular signaling by CD4 directs the development of thymocytes to a CD4 lineage. A hybrid protein consisting of the CD8 extracellular and transmembrane domains and the cytoplasmic domain of CD4 (CD884) should bind class I MHC but deliver a CD4 intracellular signal. We find that expression of a hybrid CD884 protein in thymocytes of transgenic mice leads to the development of large numbers of class I MHC-specific, CD4 lineage T cells. We discuss these results in terms of current models for CD4 and CD8 lineage commitment.

Animals↗
PubMed1996

Characterization of an intronless CD4 minigene expressed in mature CD4 and CD8 T cells, but not expressed in immature thymocytes.

The expression of the CD4 gene undergoes a complex pattern of regulation during T cell development. Results obtained in transgenic mice suggest that a combination of proximal enhancer and a silencer from the CD4 gene is sufficient to obtain a developmentally controlled expression along T cell maturation. We generated transgenic mice expressing the human CD4 cDNA under the control of the human CD4 promoter and the murine CD4 minimal proximal enhancer. No other regulatory sequences, including the silencer, were included. The pattern of expression of this transgene is restricted to mature peripheral T cells, to the only mature heat-stable Ag(HSA)low/- single positive thymocytes, and to some NK cells. Surprisingly, no expression was found in double positive or in immature HSAhigh single positive thymocytes. These results suggest that additional, yet uncharacterized genomic sequences are necessary for CD4 expression in immature thymocytes and that there is a change in transcription factors occurring at the late states of T cell development. Finally, since this is the first combination of regulatory sequences that possess such a T mature specific pattern of expression, it should provide a novel tool to address several immunologic questions or for therapeutic purposes.

Animals↗
PubMed1996

Development of a defined medium fermentation process for physostigmine production by Streptomyces griseofuscus.

Physostigmine is a plant alkaloid of great interest as a therapeutic candidate for the treatment of Alzheimer's disease. Fortunately, this compound is also produced by Streptomyces griseofuscus NRRL 5324 during submerged cultivation. A fermentation process that used chemically defined medium was therefore developed for its production. By means of statistical experimentation, the physostigmine titer was quickly increased from 20 mg/l to 520 mg/l with a culture growth of 19 gl dry cell weight on the shake-flask scale. Further medium optimization resulted in a yield of 790 mg/l in a 23-1 bioreactor using a batch process. A titer of 880 mg/l was attained during scale-up in a 800-1 fermentor by employing a nutrient-feeding strategy. This production represents a 44-fold increase over the yield from the initial process in shake-flasks. The defined-medium fermentation broth was very amenable to downstream processing.

Cholinesterase Inhibitors↗
PubMed1996

The Patient Requests Form: a way of measuring what patients want from their general practitioner.

A consumer-oriented approach to the delivery of health care and an understanding of the processes that influence clinical management decisions require the measurement of what patients seek when they consult their doctor. The present study completed the development of an instrument (the Patient Requests Form) that can quantify the intentions of patients attending their general practitioner. The Patient Requests Form was completed by 410 patients attending two general practices: one in an inner city area, the other in a small town. Principal components analysis revealed that the responses from each sample yielded identical components that described three distinct types of request: (i) for explanation and reassurance, (ii) for emotional support, and (iii) for investigation and treatment. Scales constructed to measure each type of request have high internal consistency while being sufficiently brief to be acceptable to general practice patients. The Patient Requests Form is a novel, convenient method to quantify the intentions of patients when they consult a general practitioner. It permits research into neglected aspects of consultation behaviour, including the factors that influence patients' intentions to seek different kinds of help and GPs' perceptions of these intentions.

Adolescent↗
PubMed1996

The relationship of childhood physical and sexual abuse to adult illness behavior.

A sample of 275 undergraduate subjects reported (i) their history of sexual and physical abuse in childhood and (ii) their health care utilization, somatization, and hypochondriasis as an adult. Physical and sexual abuse were recalled by largely separate groups, physical abuse predominating in males and sexual abuse in females. Both types of abuse were followed by a greater number of hospital admissions and surgical procedures in adulthood. Although sexual, and especially physical, abuse were associated with recall of emotionally disturbed parenting, this could not explain their influence on health care utilization because this was unrelated to parenting. Similarly, although abuse was followed by greater somatization and hypochondriasis, these also were unrelated to health care utilization. Physical and sexual abuse in childhood are risk factors, independent of their association with poor parenting, in the development of separate aspects of adult illness behavior.

Adolescent↗
PubMed1996

Fatigue after major joint arthroplasty: relationship to preoperative fatigue and postoperative emotional state.

Fatigue has been widely assumed to increase after major surgery, and possible physical explanations have been intensively investigated. Nevertheless, existing data are almost exclusively from abdominal surgery and are based on the use of a single visual analogue scale. Moreover, no physical basis has been found. The present study used a more homogeneous surgical model than has been employed hitherto in order to find whether fatigue was related to emotional state. We measured fatigue before and 1 and 7 weeks after major joint arthroplasty in 63 patients, using a questionnaire that separates mental and physical fatigue. Physical function and subjective emotional and somatic state were measured at the same times; optimism was measured preoperatively. Neither mental nor physical fatigue increased after this form of surgery. Mental and physical fatigue each correlated with low positive mood throughout. The best predictor of physical fatigue postoperatively and at follow-up was preoperative physical fatigue. Preoperative mental fatigue and negative mood were independent predictors of mental fatigue postoperatively and at follow-up. Preoperative fatigue also predicted worse subjective emotional and physical state after surgery. These results suggest that fatigue should be regarded as an aspect of emotional distress perioperatively and that complaints of fatigue postoperatively may reflect the tendency to complain of fatigue or negative mood preoperatively rather than being attributable to surgical trauma.

Aged↗
PubMed1996

The measurement of beliefs about physical symptoms in English general practice patients.

A way of measuring patients' beliefs about the origin of their symptoms would allow the investigation of important questions concerning the consultation process and its outcome. The purpose of this study was to develop an instrument that could measure the beliefs about symptoms of patients attending their general practitioner and to demonstrate its utility by comparing beliefs about three types of symptom (respiratory, musculoskeletal and gastrointestinal). Interviews of 150 patients generated items for the belief questionnaire which was then completed by a second sample of 406 general practice patients. Principal components analysis of the responses identified eight readily interpretable belief dimensions: stress; lifestyle; wearing out; environment; internal-structural; internal-functional; weak constitution; concern. Scales were constructed to measure each dimension and the symptom groups were compared. Gastrointestinal symptoms were the most likely to be attributed to internal malfunction and to lifestyle or weak constitution. Musculoskeletal symptoms were more likely to be attributed to structural problems caused by the body wearing out and respiratory symptoms, in contrast, to the influence of the environment. Contrary to prediction, attribution to stress was made equally for the different types of symptom. We have devised a questionnaire, valid specifically for general practice patients, which permits the quantification of beliefs in this setting. The questionnaire could be used in future to track how beliefs respond to medical intervention and how, in turn, beliefs influence illness behaviour.

Adolescent↗