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Biomedical subjects

S C Thompson

Publications and source records attributed to S C Thompson.

At least 55 records · Page 3Linked to original sources
PubMed1996

HIV in the mentally ill.

OBJECTIVE: To review the published literature in relation to prevalence of HIV infection and risk behaviours for HIV among the mentally ill to assist in the development of appropriate strategies for public health policy, surveillance and clinical management of HIV and HIV risk in these groups. METHOD: A search of published literature was carried out using 'Medline', in association with following up appropriate papers cited in the references of journals identified. RESULTS: The North American literature shows an increased risk of HIV infection in psychiatric patients receiving treatment in both inpatient or community settings. HIV infection is associated with a number of risk behaviours, particularly male homosexual sex and injecting drug use, and being the sexual partner of a person with a history of these. Impulsivity, high levels of sexual activity during acute exacerbations of psychiatric illness, poor skills at negotiating safe sex, homelessness and drug abuse are all risk behaviours common among those affected by some mental illnesses. The mentally ill also have a comparatively poorer knowledge of HIV/AIDS. There is a dearth of published Australian data addressing the question of HIV seroprevalence or risk in the mentally ill. Although there has been development and implementation of HIV risk-reduction programs overseas, the development and evaluation of any programs in Australia has not been published. CONCLUSIONS: Arguably, Australia has developed a comprehensive program of national surveillance for HIV infection and has been relatively successful in its response to the HIV epidemic, with the high rates of infection in the early to mid-1980s substantially reduced to around 600 new diagnoses per year. However, while risk behaviours which exposed those infected with the virus are recorded, underlying conditions which predispose them to these behaviours are not. Nevertheless, there is HIV infection amongst mentally ill and intellectually disabled people in Australia. Examination of the North American experience reveals opportunities to prevent a high rate of HIV infection in those with mental illness in Australia. Such a program would require adequate risk behaviour assessment, appropriate diagnostic testing and management, and development of specific educational interventions which are properly evaluated to ensure their effectiveness.

Adolescent↗
PubMed1995

Ascertaining exposure categories of HIV-infected individuals with previously unrecorded risk data.

OBJECTIVES: To improve the quality of surveillance data for HIV in Victoria by following up all cases with an unknown exposure category; and to determine whether those with no exposure category included cases of transmission other than via the conventionally recognised routes. METHODS: The Victorian HIV database records data on all people diagnosed with HIV in Victoria, including information on route of exposure to the virus. We identified all HIV diagnoses to which no exposure category had been attributed and, with the permission of the State Minister for Health, obtained access to namecoded testing records. Exposure categories, where possible, were obtained directly from these records. Otherwise, cases were checked against the namecoded AIDS database and, if necessary, an intensive process of call-back to laboratories, diagnosing doctors and HIV treatment centres was undertaken. RESULTS: The database initially contained records for 289 people with unknown exposure categories (9.1% of Victorian people with HIV infection). We identified exposure categories for 155 of these people. CONCLUSIONS: Exposure categories for those cases previously without data were similar to those for cases where exposure category was known. No instances of HIV transmission by previously unrecognised means were detected.

Data Collection↗
PubMed1995

The effect of regular sunscreen use on vitamin D levels in an Australian population. Results of a randomized controlled trial.

BACKGROUND AND DESIGN: Studies published have suggested a possibility that regular use of sunscreen to prevent skin cancer may put the population, particularly elderly people, at risk of vitamin D deficiency. We aimed to determine whether regular use of sunscreens in the normal adult population, as recommended by public health authorities for the prevention of skin cancer, may put individuals at risk of vitamin D deficiency. A randomized double-blind control trial of the daily use of a broad-spectrum sunscreen (sun protection factor [SPF] 17) vs placebo cream over a summer period in Australia was conducted in 113 people aged 40 years and over, with sampling stratified by age. All participants had at least one solar keratosis. Serum samples taken at the beginning and at the end of the study were analyzed for 25-hydroxyvitamin D3 and 1,25-dihydroxyvitamin D3. RESULTS: Mean levels of 25-hydroxyvitamin D3 rose significantly by the same amount in both groups over the period of the study (placebo, +12.8 mmol/L; sunscreen, +11.8 mmol/L). Mean levels of 1,25-dihydroxyvitamin D3 increased significantly in the placebo group only (placebo, +10.8 pmol/L; sunscreen, +1.3 pmol/L), but for no subject in either group was the level of 1,25-dihydroxyvitamin D3 outside the reference range either at the start or at the end of the study. There were no significant differences by age, sex, and skin type in the change in 25-hydroxyvitamin D3 or 1,25-dihydroxyvitamin D3 over the study period. CONCLUSIONS: No person, including those aged 70 years and over, developed any vitamin D levels outside the normal reference range during the period of the study. The data suggest that over an Australian summer sufficient sunlight is received, probably through both the sunscreen itself and the lack of total skin cover at all times, to allow adequate vitamin D production in people who are recommended to use sunscreens regularly. More work is required to elucidate the relationship between 25-hydroxyvitamin D3 and 1,25-dihydroxyvitamin D3, particularly during the different seasons of the year.

Adult↗
PubMed1994

Primary versus secondary and central versus consequence-related control in HIV-positive men.

Two dimensions of perceived control (primary vs. secondary and central vs. consequence-related) were examined in a sample of 104 HIV-positive men. Two hypotheses regarding the use of primary control (acting to achieve specific outcomes) and secondary control (acceptance) were supported: The use of both primary and secondary control was associated with better adjustment. Secondary control served a protective role at lower levels of primary control, but was not associated with adjustment at higher levels of primary control. The 2 hypotheses regarding central control (over the infection) and consequence-related control (over consequences of the infection) were also supported. Perceptions of consequence-related control were higher than perceptions of control over HIV and more strongly associated with low depression.

Adaptation, Psychological↗
PubMed1994

Infectious diarrhoea in children: controlling transmission in the child care setting.

An increase in the number of preschool children cared for within groups in child care centres has been associated with increasing numbers of women in the workforce. Children at this age are at high risk for gastrointestinal diseases caused by a large number of enteric pathogens, and the risk is increased by the greater potential for person-to-person transmission within group care. This report considers the pathogens that may cause diarrhoeal illness in children, with particular reference to those that have been reported in formal day care settings. The major risk factors for transmission of these agents and a high rate of diarrhoeal illness in the child care setting include attendance of non-toilet-trained children, staff combining nappy changing and food preparation duties, large enrollment, low staff-to-child ratio, and poor hygiene and child handling practices. Investigations undertaken during an outbreak of diarrhoea have frequently used limited diagnostic testing, often suitable for identifying only bacterial and protozoal agents. Such limited investigations have tended to incriminate agents that have prolonged carriage and are easily identifiable in standard microbiology laboratories. Finding a pathogen in these circumstances needs to be interpreted with caution. Prevention and control measures include training and education in good personal hygiene, emphasis on the need for frequent handwashing, separation of change areas from food handling and eating areas, routine cleaning and disinfection of environmental surfaces and personal items, and exclusion of any child or child care worker with diarrhoea.

Acute Disease↗
PubMed1994

Legislation for school entry immunisation certificates in Victoria.

In 1982 the National Health and Medical Research Council recommended that every state introduce legislation requiring immunisation certificates at school entry. Victoria was the first state to enact such legislation. This paper explores the process and difficulties encountered in achieving this legal requirement, describes the requirements under the legislation as it was finally introduced, and examines the early data available to the state health department regarding its implementation. Compliance with the legislation and immunisation status of children enrolling in government primary schools were ascertained from mid-year census data. In 1992 almost 90 per cent of children complied with the legislation, but because 10.2 per cent of children did not present a certificate it was possible to estimate only the lower limit of statewide coverage at 85 per cent against the prescribed diseases. School entry immunisation legislation may provide an important safety net to identify children with incomplete immunisation. However, the effectiveness of the legislation in Victoria remains unproven, and the requirements of the legislation are demanding for parents, local councils, and schools. The failure to document immunisation status in over 10 per cent of children indicates that further efforts to increase compliance are needed. This will require information on the vaccination status of those without certificates and the reasons they have not complied. The impact of the legislation needs further evaluation, although it may be years before its effectiveness can be gauged. Its effectiveness may depend upon enforcement of the requirement to exclude unimmunised children in disease outbreaks.

Child↗
PubMed1994

An evaluation of school entry immunisation certificates in Victoria.

We evaluated legislation introduced into Victoria in 1991 requiring that all children enrolling in primary school certify their immunisation status. Information was requested from all local councils. All primary schools in two local government areas were followed up, providing an indication of the validity of the analysis obtained from data collected during the mid-year census. From 166 of 210 local councils in Victoria, 48,422 documents relating to school entry immunisation certificates were issued for children entering their preparatory year. At least 522 children were enrolled in school on an undertaking to complete immunisation, and were likely to have had their immunisation completed as a result of the legislation. Only 170 statutory declarations of conscientious objection to immunisation were made, indicating that few parents are willing to express firm anti-vaccine sentiments. Compliance with the immunisation certificate legislation is overestimated by the mid-year census because many schools have accepted nonstatutory evidence of immunisation. Mobile and immigrant families find it particularly difficult to achieve certification. Local councils are inconsistent in the way in which they issue certificates. Further follow-up and feedback is essential to better inform schools and parents about the legislation. Such follow-up can improve the certification rates of children then and in subsequent years. The legislation has imposed a considerable workload on councils, but without efforts to improve compliance with the legislation and to develop practical guidelines for documentation of immunisation and appropriate guidelines regarding transfer, many inadequately immunised children may remain at risk from vaccine-preventable diseases.

Child↗
PubMed1994

Surveillance for sexually transmissible diseases in Victoria, 1983 to 1992.

Surveillance systems have been developed in Victoria to determine trends in sexually transmissible diseases (STDs). Notifications to the Health Department (including laboratory notification since May 1990) have been supplemented by data about strains of Neisseria gonorrhoeae and cultures for Chlamydia trachomatis processed by the Microbiological Diagnostic Unit, enhanced laboratory surveillance of syphilis, and data on genital herpes and genital warts from the Melbourne Sexual Health Centre. During the period under review the incidence of gonorrhoea declined, rapidly at first, and then more slowly. For women, this trend has continued, while gonorrhoea acquired abroad by men has become relatively more important. Since 1988, gonorrhoea in homosexual men has increased, and rectal isolates have increased concurrently, raising concerns about HIV risk behaviour. Cases of syphilis are likely to be ascertained through STD, antenatal and refugee screening, rather than because of symptoms or contact tracing. Chlamydia is a the most common notifiable STD, despite underreporting and underdiagnosis. In 1991, 832 cases were notified, increasing to 1377 in 1992. In 1992, of the 73 cases (65 per cent of notifications) where the doctor identified a risk, 15 per cent was attributed to homosexual contact, and 27.4 per cent to heterosexual exposure. Limitations in the data include inadequate standard case definitions for many STDs, changes in the statutory requirement for notifications in 1990, underreporting, changes in diagnostic and screening patterns, and lack of detailed demographic data. Education of general practitioners is needed to improve diagnosis and notification of chlamydia.

Adult↗
PubMed1993

Preferences for involvement in medical decision-making: situational and demographic influences.

We examined desires to be involved in decisions about one's own medical treatment in a sample of 459 health maintenance organization members. Demographic variables (age, sex and education level) that have been found to be related to decision preferences were also tested. As predicted, respondents expressed a desire to be involved in decisions that do not require medical expertise, but had significantly lower preferences for involvement in decisions that required medical expertise. Younger and better-educated individuals reported a higher desire for involvement, but there were no sex differences in preferences. The higher desire for involvement in decisions not requiring medical knowledge was found both for groups that traditionally have wanted involvement and for those that have not. The implications of the results for patient participation in decision-making are discussed.

Adult↗
PubMed1993

Reduction of solar keratoses by regular sunscreen use.

BACKGROUND: The incidence of and mortality from skin cancer are increasing in many countries. In view of the added concern about ozone depletion, many organizations are promoting the regular use of sunscreens to prevent skin cancer, despite the absence of evidence that these products have this effect. Solar (actinic) keratosis is a precursor of squamous-cell carcinoma of the skin. METHODS: We conducted a randomized, controlled trial of the effect on solar keratoses of daily use of a broad-spectrum sunscreen cream with a sun-protection factor of 17 in 588 people 40 years of age or older in Australia during one summer (September 1991 to March 1992). The subjects applied either a sunscreen cream or the base cream minus the active ingredients of the sunscreen to the head, neck, forearms, and hands. RESULTS: The mean number of solar keratoses increased by 1.0 per subject in the base-cream group and decreased by 0.6 in the sunscreen group (difference, 1.53; 95 percent confidence interval, 0.81 to 2.25). The sunscreen group had fewer new lesions (rate ratio, 0.62; 95 percent confidence interval, 0.54 to 0.71) and more remissions (odds ratio, 1.53; 95 percent confidence interval, 1.29 to 1.80) than the base-cream group. There was a dose-response relation: the amount of sunscreen cream used was related to both the development of new lesions and the remission of existing ones. CONCLUSIONS: Regular use of sunscreens prevents the development of solar keratoses and, by implication, possibly reduces the risk of skin cancer in the long-term.

Adult↗
PubMed1993

Booster doses of hepatitis B vaccine: responses to low-dose inoculations.

OBJECTIVE: To examine the anamnestic response to hepatitis B vaccine in previously vaccinated subjects. DESIGN: Subjects who had received a course of hepatitis B vaccine at least two years previously had a sample of blood taken before and seven days after a low-dose booster of hepatitis B vaccine. SETTING AND PARTICIPANTS: A pilot group of laboratory scientists in the Microbiological Diagnostic Unit; fifth year medical students, University of Melbourne; and a group of ambulance officers from the Geelong Ambulance Depot (Victoria). All participants volunteered after having been informed of the study. OUTCOME MEASURES: Serum levels of antibody to hepatitis B surface antigen (HBsAg) were measured before and after the booster dose of vaccine and, when available, in serum taken a month after the end of the primary course of vaccine, and the changes in antibody level were studied. RESULTS: Although some individuals with a restricted antibody response were identified, most showed a quick response. There was limited evidence that this rise peaked early and began to fall within weeks. CONCLUSIONS: In many subjects, levels of antibody to HBsAg peak early after booster doses of vaccine but the rapid anamnestic response to small amounts of antigen make it probable that effective protection from symptomatic illness may be long lasting, when there has been a satisfactory primary response. This provides an argument for testing for adequate seroconversion after vaccination.

Adult↗
PubMed1993

Effectiveness of low-dose intradermal hepatitis B vaccination. Five years' experience of primary vaccination.

OBJECTIVE: To determine whether intradermal hepatitis B vaccination is an effective procedure. DESIGN: A study of antibody responses to hepatitis B vaccine in 753 medical students. SETTING: Routine vaccination of medical students with intradermal doses of hepatitis B vaccines of various origins. OUTCOME MEASURES: Rates of seroconversion and geometric mean levels of antibody achieved. RESULTS: Seroconversion rates, indicated by antibody to hepatitis B surface antigen (anti-HBs) levels of 10 mIU/mL or more, varied between 82% and 94.7% with different preparations of the vaccine. With a four-dose intradermal schedule over two successive cohorts, Engerix-B (SmithKline Beecham) gave better responses, in this context, than H-B-Vax II (Merck Sharp & Dohme). Any reactions to the vaccination were mild and local. CONCLUSION: The intradermal route is a practical method of vaccination against hepatitis B in healthy young adults when the cost of the vaccine is an inhibiting factor.

Adult↗
PubMed1993

Maintaining perceptions of control: finding perceived control in low-control circumstances.

Three questions about the role of perceived control in coping with a major life stressor were addressed in a sample of 71 cancer patients. As expected, those with greater perceptions of control were less depressed, even when physical functioning, marital satisfaction, and negative affectivity were controlled for. Consistent with a compensatory model of control, it was more important for patients to believe that they could control daily emotional reactions and physical symptoms than the course of the disease. Patients who endorsed irrational beliefs had lower overall perceptions of control. The results indicated that even patients who were physically or psychosocially worse off were better adjusted if they had higher perceptions of control.

Adaptation, Psychological↗
PubMed1993

Counselling patients to make lifestyle changes: the role of physician self-efficacy, training and beliefs about causes.

Three factors that might help explain the extent to which physicians counsel patients to quit smoking and lose weight were examined: counselling self-efficacy, training in behaviour change and beliefs about causes of smoking and being overweight. More aggressive counselling was defined as counselling more patients per month and following up on counselling recommendations. Questionnaires were returned by 85 health maintenance organization physicians. As predicted, physicians with a stronger sense of counselling self-efficacy, and those who had received education in health behaviour change techniques were more aggressive counsellors. Motivational strategies were also explored. Physicians' beliefs about the causes of smoking and being overweight were related to the use of some types of strategies. Implications for increasing physician counselling patients to make behaviour changes are discussed.

Attitude of Health Personnel↗