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Biomedical subjects

R Freeman

Publications and source records attributed to R Freeman.

At least 181 records · Page 10Linked to original sources
PubMed1995

Recovery and relapse in adolescents with bipolar affective illness: a five-year naturalistic, prospective follow-up.

OBJECTIVE: This study was a 5-year naturalistic prospective follow-up of 54 consecutive admissions of adolescents to a university inpatient service with a diagnosis of bipolar I affective illness. METHOD: Subjects received structured clinical evaluations every 6 months after entry to establish time to recovery and subsequent relapse. Regression models were used to identify predictors of differential course. RESULTS: Rate of recovery varied by polarity of episode at time of entry, with quick recovery observed in subjects with pure mania or mixed states, and a protracted index episode in subjects with pure depression. Multiple relapses were most often seen in subjects with mixed or cycling episodes at intake. CONCLUSIONS: Polarity of illness may have utility in identifying bipolar adolescents with a more recurrent illness. Comparison with adult data suggests that recurrence risks may vary as a function of age at onset or stage of the disease process.

Adolescent↗
PubMed1995

Prevention and government: health policy making in the United Kingdom and Germany.

The gap between rhetoric and reality in health policy making for disease prevention services is well recognized. I do not try once more to close the gap, but rather argue that the rhetoric of prevention is politically significant. Beginning with an account of prevailing explanations of prevention in policy making, I explore the idea that prevention has a pervasive legitimacy in health politics. This affords opportunities for instrumental policy making by government. To this end, I concentrate on the relationship between disease prevention and health care delivery, discussing in detail the association between prevention and health care reform. My arguments are based on case studies of policy making in Germany and the United Kingdom. I discuss implications for understanding the core interests of government, physicians, and users with respect to prevention in health policy making. The concluding section offers comparative commentary on the role of disease prevention in health sector restructuring.

Cross-Cultural Comparison↗
PubMed1995

Health directed and health related dimensions of oral health behaviours of periodontal referrals.

The aim of this study was to investigate attitudes and oral health behaviours of people referred to a specialist periodontal clinic. The method of Ajzen and Fishbein was used to construct a questionnaire to examine the attitudes and the influence of 'important others' associated with the oral health of a consecutive group of 214 first time attenders at a hospital periodontal clinic. The mean age of those investigated was 38.8 (SD 11.2) years. They were predominantly female (66 per cent) and from a higher socioeconomic status group (66 per cent). Significantly more of those in a high oral health behaviour group scored higher for the dental health attitudes--'clean teeth' and 'fresh breath'--and for the 'important other', the dentist. This suggested that two sets of attitudes existed--health related and health directed--and that the dentist was the most salient referent. Principle components analysis demonstrated the dual nature of attitude and suggested that family and friends were also influential 'important others'. This suggested a clash exists between lay and professional dental health perspectives. Clinicians should be aware that patients who are referred for consultations to their clinics arrive with their own strongly held attitudes and beliefs, appearing to value the advice of family as well as that of the dental health professional.

Adult↗
PubMed1994

Nosocomial infection due to enterococci attributed to a fluidized microsphere bed. The value of pyrolysis mass spectrometry.

The potential of fluidised microsphere beds as sources of nosocomial Enterococcal infection was investigated with the help of pyrolysis mass spectrometry. Isolates from clinical specimens collected from two patients who were nursed sequentially on a fluidized microsphere bed were compared with similar isolates cultured from the microspheres before and after decontamination. Pyrolysis mass spectrometry confirmed that nosocomial spread had indeed occurred and that the existing decontamination process was inadequate. Recommendations for improvements to this decontamination process appear to have prevented further cases.

Adult↗
PubMed1994

Outcome of Toxoplasma gondii mismatches in heart transplant recipients over a period of 8 years.

Donor-related infection due to Toxoplasma gondii is a well-recorded complication of cardiac transplantation. In order to assess the efficacy of co-trimoxazole in small doses as prophylaxis for primary Toxoplasma gondii infection in seronegative heart and heart-lung transplant recipients receiving organs from seropositive donors, we reviewed the serostatus and clinical outcome of all such mismatched transplants performed at our unit over a period of 8 years. Of 310 transplants performed between May 1985 and May 1993, donor and recipient serum samples were available for 257 heart and 33 heart-lung transplants. Of these, 13 (4.5%) were toxoplasma mismatches. Post-transplant review serum samples were available for 3 months or longer for nine of the 13 mismatches. The first three patients received co-trimoxazole 480 mg bd orally for 3 months (regimen A) while the remainder received only the standard prophylaxis designed for Pneumocystis carinii i.e., 960 mg bd orally three times per week for 3 months (regimen B). Seroconversion was demonstrated in only one patient (regimen A). Furthermore, none of the mismatched patients developed serious infection compatible with primary toxoplasmosis. We therefore conclude that in centres with a low prevalence of toxoplasma seropositivity, testing of donor and recipient serum for Toxoplasma gondii antibody should be performed only when clinically indicated and, in addition, standard prophylaxis for Pneumocystis carinii may be adequate for preventing primary toxoplasmosis.

Adolescent↗
PubMed1994

Calcitonin gene-related peptide and the kidney.

Calcitonin gene-related peptide (CGRP) is a recently discovered neurotransmitter that is extensively localized in fibers innervating vascular and endocrine systems. CGRP possesses potent vasorelaxant effects, and a role for this peptide in the regional regulation of blood flow has been suggested. Although pharmacologic evidence indicates that the renal vasculature is very sensitive to CGRP, the physiologic actions of this peptide on the kidney have not yet been fully elucidated. This short review focuses on relevant experimental and clinical information of the direct and indirect effects of CGRP on renal function with an emphasis on hemodynamics, sodium excretion, and the renin-angiotensin system.

Animals↗
PubMed1994

Rapid identification of species within the Mycobacterium tuberculosis complex by artificial neural network analysis of pyrolysis mass spectra.

An artificial neural network (ANN) was trained to distinguish between Mycobacterium tuberculosis and M. bovis with averaged pyrolysis mass spectra from duplicate subcultures of four strains of each of these species, each pyrolysed in triplicate. Once trained, the ANN was interrogated with spectrum data from the original organisms (the "training set") and from 26 other mycobacterial isolates (the "challenge set") of the M. tuberculosis complex (MTBC). Eight strains of M. bovis and 13 of M. tuberculosis, whether sensitive or variously resistant to antituberculosis drugs, were identified in agreement with conventional identification. Four strains of "M. africanum" were identified as M. bovis. Of two atypical M. tuberculosis strains from South India, one was identified as M. tuberculosis and the other as M. bovis. Six strains of BCG proved heterogeneous; two gave equivocal identifications, three were identified as M. bovis and one was identified as M. tuberculosis.

Humans↗
PubMed1994

Application of pyrolysis mass spectroscopy and SDS-PAGE in the study of the epidemiology of Pseudomonas cepacia in cystic fibrosis.

Representative isolates of Pseudomonas cepacia from 15 cystic fibrosis (CF) patients attending the Respiratory Unit of Alder Hey Childrens' Hospital were investigated by SDS-PAGE of whole-cell polypeptides and by pyrolysis mass spectroscopy (PMS). SDS-PAGE was less discriminatory than PMS. Eleven isolates were indistinguishable by PMS and considered to represent re-isolates of an endemic strain; four isolates were distinct from this group, and from one another. P. cepacia was first isolated on the unit in July 1989 from a patient who had attended a UK selection meeting for a Canadian CF camp. A ward and outpatient segregation policy was introduced, but colonisation of further patients occurred. In August 1991, the Adult CF Association recommended that all social activities involving colonised patients should cease. This, and an increased awareness amongst older CF patients of the risks of person-to-person transmission, was associated with a marked decline in new cases. Social activity and hospital admissions were compared for colonised patients during the year before colonisation with P. cepacia, and matched patients who did not acquire the endemic strain. This showed a significantly higher attendance at CF social events for colonised patients, but no significant association between colonisation and hospital admission. These results are strong indirect evidence that transmission of P. cepacia occurs through social contact outside the hospital environment.

Adolescent↗
PubMed1994

Rapid characterisation of Candida albicans by pyrolysis mass spectrometry.

Clinical isolates (41) of Candida spp. from three possible outbreaks of nosocomially-acquired infection were compared by pyrolysis mass spectrometry (PMS) and by a combined morphotyping and resistotyping (M-R typing) method. Both systems characterised all the isolates and distinguished one isolate of C. tropicalis and another of C. glabrata from the 39 isolates of C. albicans. Results from both systems suggested that cross-infection with a single strain contributed to two of the outbreaks. In several instances, more than one strain of C. albicans was found amongst multiple isolates from the same patient. PMS is a simple, rapid and objective technique capable of characterising C. albicans isolates; discrimination was similar to M-R typing.

Candida albicans↗
PubMed1994

Crystal violet reactions of coagulase negative staphylococci.

Twenty four reference strains and 112 clinical isolates of coagulase negative staphylococci (CNS) were examined for their reactions in the crystal violet test. Some species gave a white reaction and others a purple reaction. Results were consistent and reproducible and each species gave only one pattern of crystal violet reaction. Within the limited variety of species represented in the clinical isolates, Staphylococcus saprophyticus and S haemolyticus gave crystal violet purple reactions, in contrast to S epidermidis, which always gave a white reaction. Investigations suggested that the mechanism of the crystal violet test in S haemolyticus may be similar to that previously described in S aureus. Further work is needed to characterise the ability of crystal violet to modify S epidermidis and other central nervous system species. The crystal violet reaction, which has strong associations with invasiveness, phage group susceptibilities, colonisation persistence abilities, and nosocomial origin in S aureus may also be useful in studies of CNS disease.

Coagulase↗
PubMed1994

Psychological aspects of patient management in dental practice.

Failure to achieve good patient management will result in poor patient co-operation and potential failure of treatment. In this article, ways of establishing and maintaining good communication between the dental team and the patient are discussed.

Attitude of Health Personnel↗