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Biomedical subjects

R Kemp

Publications and source records attributed to R Kemp.

At least 19 recordsLinked to original sources
PubMed1999

Human phase I vaccine trials of 3 recombinant asexual stage malaria antigens with Montanide ISA720 adjuvant.

Two phase I vaccine trials were conducted to test the immunogenicity and safety of a vaccine containing three recombinant malaria antigens from the asexual stage of Plasmodium falciparum. The three antigens are a fragment of MSP1 (190LCS.T3); MSP2 and a portion of RESA and were formulated in Montanide ISA720 adjuvant. These trials investigated the dose response of each antigen for eliciting both antibody and T-cell responses and the immunogenicity of a mixture of the antigens compared with the antigens injected separately. All three antigens elicited both antibody and T-cell responses. Strong T-cell responses were observed with 190LCS.T3 and RESA with stimulation indices exceeding 100 for peripheral blood leucocytes in some individuals. The antibody responses were generally weak. The human antibody responses observed with MSP2 in Montanide ISA720 were not significantly different from those obtained in an earlier trial which used MSP2 with alum as the adjuvant. No antigenic competition was observed: volunteers receiving a mixture of antigens had similar responses to those receiving the three antigens at separate sites. Tenderness and pain at the injection site were common over the first few days following immunization. In some volunteers, especially those receiving the highest doses tested, there was a delayed reaction at the injection site with pain and swelling occurring approximately 10 days after injection.

Adjuvants, Immunologic↗
PubMed1998

Injecting behaviours and prevalence of hepatitis B, C and D markers in New Zealand injecting drug user populations.

AIM: To determine the seroprevalence of hepatitis C virus (HCV), hepatitis B virus (HBV) & hepatitis D virus (HDV) markers of infection among injecting drug user populations in New Zealand and to examine the relationship between demographic features, risk behaviours and infection. METHODS: A total of 323 current injecting drug users completed a questionnaire that explored their needle and syringe using behaviours. Information was collected on injection pattern, sharing behaviours and methods of cleaning needles and syringes. Two hundred and forty-one respondents gave blood samples which were tested for hepatitis B, C and D markers. RESULTS: Over half the respondents (59%) were male and 41% were female. Most (89%) identified as European. Sixty-four percent were anti-HCV positive. The likelihood of infection increased with age and duration of injecting. Forty-one percent (33/81) of those aged 25 or under, sixty-four percent (45/70) of those aged 26-30 and eighty-seven percent (78/90) over 30 were anti-HCV positive. Those who tested anti-HCV positive had been injecting for an average of 12.0 years compared to 6.0 years for those were anti-HCV negative. The results for hepatitis B are to be reported fully at a later date. Sharing behaviour was also a factor although this was less important as an independent factor. Comparisons with earlier surveys suggested that there has not been a significant decline in the rate of sharing needles and syringes since the initial period following introduction of the needle exchange programme. CONCLUSION: The prevalence of hepatitis C infection is common among injecting drug users of all ages. Without a significant reduction in sharing behaviour, particularly among younger injecting drug users, it is unlikely that the prevalence of hepatitis C among injecting drug users will decline in the future. Evidence suggests that the carriage of hepatitis C is higher than that of hepatitis B which would help explain the differing rates of prevalence. However, the risk of future transmission of other parenterally transmitted diseases remains high without a further significant decline in sharing behaviour.

Adolescent↗
PubMed1998

A comparative study of insight scales and their relationship to psychopathological and clinical variables.

BACKGROUND: Research on the subject of insight has been hampered by difficulties in definition and reliable measurement. METHODS: We compared several rating scales to measure insight on a group of 33 psychotic patients as well as assessing patients' psychopathology, clinical characteristics and cognitive functioning. RESULTS: Most currently used scales showed a high degree of inter-correlation. Measures of insight related strongly to the presence of delusions; grandiosity (inversely), and depression (positively). Higher insight scores correlated with indices of treatment compliance and inversely with substance abuse. Measures of pre-morbid IQ and impaired executive functioning, including the Wisconsin Card Sorting Test were not associated with poor insight. CONCLUSIONS: The study highlights aspects of psychopathology and clinical variables particularly related to insight and supports the continued use of standardized scales in further research in this area.

Adult↗
PubMed1998

Religious faith after psychotic illness.

Religion can play an important role in the lives of psychiatric patients. We assessed how often a psychotic illness can lead to a change in the strength of religious faith and how commonly religion is used for coping with such illnesses in a sample of consecutively admitted patients. 52 patients with psychosis were interviewed regarding their religious beliefs after their index admission. 69.4% of the patients were religious, and 11 (22.4%) stated that religion was the most important part of their lives. 30.4% of the sample described that there had been an increase in their religiousness after the onset of illness. 61.2% of patients were using their religion for coping with the illness. Such patients had a better insight into their illness and were more compliant with antipsychotic medication. We conclude that the experience of a psychotic illness is likely to lead to an increase in religious beliefs. Such beliefs are commonly used for coping with the illness and some patients attach a great importance to them.

Adaptation, Psychological↗
PubMed1998

Randomised controlled trial of compliance therapy. 18-month follow-up.

BACKGROUND: A randomised controlled trial was conducted in an acute treatment setting to examine the effectiveness of compliance therapy, a brief pragmatic intervention targeting treatment adherence in psychotic disorders, based on motivational interviewing and recent cognitive approaches to psychosis. METHOD: Seventy-four patients with psychotic disorders according to DSM-III-R criteria recruited from consecutive admissions to an acute in-patient unit, received 4-6 sessions of either compliance therapy or non-specific counselling, and were followed-up over 18 months. The principal outcome measures were observer-rated compliance, attitudes to treatment, insight and social functioning. RESULTS: Significant advantages were found for the compliance therapy group post-treatment on measures of insight, attitudes to treatment and observer-rated compliance which were retained over the follow-up period. Global social functioning improved relatively more over time in the compliance therapy group compared with the control group. Survival in the community prior to readmission was significantly longer in the compliance therapy group. CONCLUSIONS: The results support the effectiveness of compliance therapy in improving functioning and community tenure after an acute psychotic episode.

Acute Disease↗
PubMed1998

Cost-effectiveness evaluation of compliance therapy for people with psychosis.

BACKGROUND: Non-compliance rates with antipsychotic medication can be high, and the personal and societal costs are considerable. A new psychological intervention, compliance therapy seeks to improve compliance and patient outcomes and reduce treatment costs. METHOD: A randomised controlled study examined the cost-effectiveness of compliance therapy compared to non-specific counselling over 18 months for 74 people with psychosis admitted as inpatients at the Maudsley Hospital. Bivariate and multivariate analyses were conducted to test for differences and to explore inter-patient cost variations. RESULTS: Compliance therapy is more effective and is no more expensive. Consequently, compliance therapy is more cost-effective than non-specific counselling at six, 12 and 18 months. CONCLUSIONS: There are compliance, outcome and cost-effectiveness arguments in favour of compliance therapy in preference to non-specific counselling.

Adult↗
PubMed1997

Cloning of cold-inducible dehydrin-like genes from the blackcurrant (Ribes nigrum L.) using RT-PCR.

A method is described for the identification of conserved genes in one plant species by using sequence information on internal motifs from well-characterized clones from another species. This sequence information is used to design primers for reverse transcriptase polymerase chain reaction (RT-PCR) and to design oligonucleotide probes to identify genuine positive amplification products. The approach was successfully used to clone cDNAs encoding cold-inducible dehydrin-like genes from the woody perennial blackcurrant, Ribes nigrum L. The strategy described can accelerate the cloning of heterologous cDNAs and is a convenient alternative to direct screening of cDNA libraries.

Amino Acid Sequence↗
PubMed1997

Phase I trial in humans of an oil-based adjuvant SEPPIC MONTANIDE ISA 720.

Seppic MONTANIDE ISA 720 is a metabolizable oil adjuvant that has given good results in animals with recombinant malarial antigens. Twelve human volunteers were given increasing intramuscular doses of MONTANIDE ISA 720, ranging from 0.6 to 1.8 ml. The adjuvant was well tolerated with only minor local effects, including tenderness, local swelling and discomfort on use. MONTANIDE ISA 720 may prove to be an acceptable and effective adjuvant for use in people.

Adjuvants, Immunologic↗
PubMed1997

Reasoning and delusions.

BACKGROUND: Delusions are assumed to reflect disordered reasoning. but with little empirical support. We attempted to study this in 16 relatively intelligent deluded patients and 16 normal volunteers. METHOD: Standard tests were used which required subjects to choose between logically fallacious and valid responses, both of which were plausible. The tests were: (a) conditional statements (if...then), (b) syllogisms (e.g. no A are C, some B are C, some C are not A), and (c) judgements of probability. All three tasks incorporated neutral and emotive content. RESULTS: Both normal and deluded subjects frequently made logical errors. With conditionals, deluded subjects tended to endorse fallacies more often than normal controls and this was accentuated when the content was emotive. Similarity, with syllogisms, the effect of emotional content on the endorsement of unbelievable responses was increased slightly in the deluded group. Finally, the deluded patients showed a trend to be less prone to the conjunction fallacy than normals, suggesting less reliance on existing schema. conclusions: Differences in reasoning between deluded patients and controls are surprisingly small. Patients are somewhat more prone to endorse invalid or fallacious responses, especially when emotive themes are involved.

Adult↗
PubMed1996

Compliance therapy in psychotic patients: randomised controlled trial.

OBJECTIVE: To determine whether compliance therapy, a cognitive-behavioural intervention, could improve compliance with treatment and hence social adjustment in acutely psychotic inpatients, and if so, whether the effect persisted six months later. DESIGN: Randomised controlled trial of compliance therapy and non-specific counselling, each comprising 4-6 sessions lasting 10-60 minutes. SETTING: Acute psychiatric admissions ward serving an inner London catchment area. SUBJECTS: 47 patients with psychosis. MAIN OUTCOME MEASURES: Informant and observer reported measure of compliance; observer assessed global functioning after intervention and three and six months later; self-rated attitudes to drug treatment after the intervention and one month later; symptom scores after intervention and six months later. RESULTS: 25 patients received compliance therapy and showed significantly greater improvements in their attitudes to drug treatment and in their insight into illness and compliance with treatment compared with the control group. These gains persisted for six months. The intervention group was 5.2 times more likely than the control group to reach a criterion level of compliance (95% confidence interval 1.5 to 18.3). Global functioning showed a tendency to improve more in the intervention group after a delay (odds ratio 3.0 (0.8 to 11.5) to reach the criterion level at six months). Four subjects given compliance therapy and six in the control group were readmitted during follow up (odds ratio 2.0 (0.48 to 8.2)). CONCLUSIONS: Compliance therapy is a pragmatic method for improving compliance with drug treatment in psychotic inpatients and its gains persist for at least six months. Overall functioning may also be enhanced.

Acute Disease↗
PubMed1996

Perception and recognition of normal and negative faces: the role of shape from shading and pigmentation cues.

A face is surprisingly difficult to recognise when presented in photographic negative, and negation has also been shown to affect simple perceptual judgments about a face. Two possible explanations for this effect are examined. In the shape-from-shading explanation it is argued that negating an image results in an impossible pattern of shading, and that this disrupts the formation of a three-dimensional representation of the surface geometry of the face. In an alternative account for this effect it is suggested that identification errors occur as a consequence of changes to the apparent pigmentation of the face caused by negating the image. Three experiments are reported which are designed to test these explanations by using novel colour-image transformations in which the hue and luminance components of images are independently manipulated. The results of these studies suggest that although changes to the apparent pigmentation of a face might result in identification errors in some situations, the loss of shape-from-shading cues is a more important cause of the negation effect. The role of these two sources of information in the recognition of normal faces is also discussed.

Face↗
PubMed1996

Australia's 'free-ride' in pharmaceuticals: can it last?

The pharmaceutical subsidy scheme in Australia works in the public interest by keeping prices low while assuring access to drugs across most of the drug classes. By separating the approval to market drugs from the decision to subsidise them, the Commonwealth is able to take advantage of its position--to 'free-ride' on research and development expenditure in other countries. The first part of this paper examines the factors which allow Australia to free-ride. The second part explores some international and domestic factors which may influence the sustainability of the free-riding strategy.

Australia↗
PubMed1996

Psychological predictors of insight and compliance in psychotic patients.

BACKGROUND: A possible neuropsychological basis for poor insight in psychosis has been proposed. Consistent supporting evidence for this is lacking. METHOD: Seventy-four consecutive acutely psychotic in-patients who were recruited for a randomised controlled trial of compliance therapy were given a battery of neuropsychological tests, along with a comprehensive clinical assessment, before and after the intervention. RESULTS: Performance on neuropsychological tests improved during the patients' admission and treatment in hospital, as did symptoms and levels of insight. Cognitive function showed no relationship to insight and compliance initially, and very little after the intervention. Factors related to insight and compliance prior to discharge included: diagnosis, attitudes to medication, side-effects, being a detained patient, and whether or not compliance therapy was given. CONCLUSIONS: Clinical variables and attitudes to treatment appear to be more relevant to compliance and the development of insight in acute psychosis than neuropsychological impairment.

Adolescent↗
PubMed1995

A case study of female genital self-mutilation in schizophrenia.

A case of deliberate genital self-mutilation in a woman with familial schizophrenia is presented. Such behaviour, though well recognized in females with severe personality disorders, is extremely rare in female psychotics. The genital mutilation may be partially understood as a consequence of delusionally motivated action against a background of low self-esteem, premorbid body-image preoccupation, forced early sexual activity and hence profound ambivalence towards adult sexuality. Dealing with this constructively was hampered by a cognitive style characterized by impaired reasoning and reality testing. Tests of reasoning, judgement and reality testing showed deficits, and computed tomography revealed dilatation of the left frontal ventricular system. Both neuropsychological and psychodynamic factors appeared to be of relevance in this case.

Adult↗