Mental health. Over the rainbow.
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Catchment Area, Health↗
Biomedical subjects
S Davies
Publications and source records attributed to S Davies.
Audit of care of newly diagnosed children with diabetes mellitus in East Anglia.
The aim of this study was to audit the organization of services and management at diagnosis of Type 1 diabetes mellitus (IDDM) in children in the eight districts of East Anglia. Representatives of each district met and agreed indicators of good practice. Service organization was assessed by questionnaire. Provision of care was audited using a proforma completed prospectively for every newly diagnosed child. Outcomes were audited by an anonymous questionnaire to families at the first outpatient appointment to assess satisfaction with care, the education received, and confidence in basic skills needed for home care of diabetes. All districts had a designated paediatric diabetic clinic, all but one led by a paediatrician. All had nurse specialists, but the posts varied widely. Only three units had joint clinics for adolescents. In total, 75% of the families returned the questionnaire. Satisfaction with support by health professionals was high. Education was good for injection technique, blood testing and diet management. Home visits by nurses were variable. Contact with schools and introduction to support groups was poor. Confidence in management was best when there was a dedicated paediatric specialist nurse with adequate cover within the team to allow home and school visits. Following peer review and implementation of an action plan, reaudit was undertaken one year later. Modest improvements were achieved in problem areas; solutions varied in different districts. Collaborative, multi-district audit allows comparison between demographically similar districts. Audit encourages improved practice within existing teams and allows an informed bid for scarce resources.
Adolescent↗
Lack of association of angiotensin II type 1 receptor gene polymorphism with diabetic nephropathy in insulin-dependent diabetes mellitus.
Several observations suggest that inherited factors are influential in the development of nephropathy in patients with insulin-dependent diabetes mellitus (IDDM). Genetic components of the renin angiotensin system are possible candidate genes. The aim of this study was to determine the role of the hypertension associated angiotensin II type 1 receptor (AT1R) gene A1166C polymorphism in susceptibility to nephropathy in IDDM. We examined 264 Caucasoid patients with IDDM and overt nephropathy (as defined by persistent proteinuria in the absence of other causes, hypertension and retinopathy), 136 IDDM patients with long duration of diabetes and no nephropathy (LDNN group), 200 recently diagnosed IDDM patients (Sporadic Diabetic group), and 212 non-diabetic subjects. The AT1R gene polymorphism was assessed using the polymerase chain reaction and restriction isotyping. Genotype frequencies did not differ significantly between the sporadic diabetic group and the nephropathy group (p = 0.245), nor between the long duration non-nephropathy group and the nephropathy group (p = 0.250). Allele frequencies were not significantly different between the three groups (p = 0.753). We conclude that there is no significant association between the hypertension associated AT1R gene polymorphism and diabetic nephropathy in patients with IDDM in the UK.
Adolescent↗
Anti-arthritic activity of hydroxamic acid-based pseudopeptide inhibitors of matrix metalloproteinases and TNF alpha processing.
OBJECTIVE AND DESIGN: The effects of two hydroxamate inhibitors of metalloproteinase and tumor necrosis factor alpha (TNF alpha) processing on endotoxin-induced plasma TNF alpha and arthritic lesions in adjuvant-induced arthritic (AA) rats were determined. MATERIAL AND TREATMENT: BB-1101 and BB-1433 were administered orally twice daily to AA Lewis rats with an established disease (days 13 to 22). AA rats (day 16) or normal rats were injected with bacterial endotoxin and plasma levels of TNF alpha were also determined. METHODS: Hindpaw swelling was measured plethysmographically. Bone degradation was determined by radiography and bone mineral densitometry. TNF alpha was quantified using a sandwich ELISA. RESULTS: The hydroxamic-acid pseudopeptides inhibited plasma. TNF alpha levels in vivo and significantly reduced swelling and bone degradation of the tibiotarsal joints of AA rats in the range of 10-50 mg/kg given orally (p < 0.01 by Student's t-test). CONCLUSIONS: Thus, these novel compounds offer a new disease modifying therapy for arthritis and the results also suggest that inhibition of TNF alpha production may contribute, at least in part, to their anti-arthritic activity.
Animals↗
The (in)stability of adolescent fears.
This study examined change in different types of fear in a longitudinal study of a birth cohort from age 13-15 yr. When viewed cross-sectionally there were few differences in the frequency and content of fears reported at these ages with the exception of an increase in social fears at age 15. When viewed longitudinally, however, few adolescents who reported fears at age 13 continued to report fears 2 yr later. Implications for developmental theories of fear and phobia are discussed.
Adolescent↗
Good teeth, bad teeth and fear of the dentist.
Studies of dental fear and oral disease suggest that conditioning processes are important in the acquisition of dental fear. At this time, however, definitive conclusions are premature as all research on the etiology of dental fear has been retrospective in design, with most confined to analogue or clinic samples. This study redressed these limitations by prospectively investigating the relationship between oral health (i.e. caries experience) at age 5 and 15 yr and the report of dental fear at age 18 in a large, unselected birth cohort. Caries experience at age 5 was not related to the development of dental fear in late adolescence. In contrast, caries experience at age 15 was significantly, and specifically, related to the report of dental fear at age 18. A ratio of caries severity at age 15, indicating the extent of multi-surface involvement, was inversely related to dental fear at age 18. This intriguing finding suggests that relatively brief dental treatment occasioned by low levels of dental disease may result in the incubation of dental fear in some individuals and that longer episodes of treatment may facilitate fear habituation. Theoretical and practical implications of these findings are discussed.
Adolescent↗
Diastereoselective resolution of 6-substituted glycosides via enzymatic hydrolysis.
The diastereoselectivity of the enzymatic hydrolyses of 4-nitrophenyl 6-deoxy-6-methyl-(R)- and (S)-sulfinyl-beta-D-galactopyranoside (1a,b), 4-nitrophenyl 7-deoxy-D- and L-glycero-beta-D-galacto-heptopyranoside (2a,b) and 4-nitrophenyl 6,7-anhydro-D- and L-glycero-beta-D-galacto-heptopyranoside (3a,b) was investigated using a range of crude glycosidase preparations. It was shown that the enzymes display a high degree of discrimination between diastereomers thereby demonstrating the utility of glycosidases for the diastereomeric resolution of unnatural 6-substituted monosaccharide derivatives.
Chromatography, High Pressure Liquid↗
Fatal acute fulminant liver failure due to clozapine: a case report and review of clozapine-induced hepatotoxicity.
Clozapine-induced hepatotoxicity is not well known and is usually of no clinical significance. This report describes fatal acute fulminant liver failure caused by clozapine in a 39-year-old man with chronic paranoid schizophrenia. The hepatotoxicity of clozapine is reviewed. Asymptomatic elevation of transaminase levels is observed most commonly, affecting between 30% and 50% of patients. Icteric hepatitis is uncommon, noted in 84 of 136,000 patients (0.06%). Fatal acute fulminant hepatitis has been documented in 2 patients (0.001%). The mechanism of clozapine hepatotoxicity is unknown. Although serious toxicity is rare, prescribers of clozapine should be aware of the hepatotoxic potential.
Acute Disease↗
8-Isoprostaglandin F2 alpha, a product of lipid peroxidation, increases portal pressure in normal and cirrhotic rats.
BACKGROUND & AIMS: The F2-isoprostanes are a recently described class of prostaglandins formed by free radical-mediated lipid peroxidation. 8-Isoprostaglandin F2 alpha (8-iso-PGF2 alpha), an F2-isoprostane, has previously been shown to be a potent renal vasoconstrictor acting via a thromboxane-like receptor. The aim of this study was to investigate whether 8-iso-PGF2 alpha increases portal pressure. METHODS: Livers from normal and bile duct-ligated cirrhotic rats were perfused, and portal pressure response to infused agonist was monitored continuously. RESULTS: Infusion of 8-iso-PGF2 alpha increased portal pressure in both groups, with a significantly greater response in cirrhotic rats. At a dose of 2.5 nmol/min, the mean portal pressure increased from a baseline of 8.2 +/- 0.6 to 9.8 +/- 1.3 mm Hg, whereas in cirrhotic animals, the increase was from 12.0 +/- 0.9 to 18.6 +/- 1.8 mm Hg. This response was completely blocked by SQ29548, a thromboxane receptor antagonist. A similar response pattern was observed with the thromboxane receptor agonist U46619. CONCLUSIONS: 8-iso-PGF2 alpha can increase portal pressure in cirrhotic rats. If extrapolated to patients with cirrhosis, lipid peroxidation secondary to alcoholic liver injury, sepsis, or other liver pathology may cause an acute increase in portal pressure such as that observed in acute liver injury.
15-Hydroxy-11 alpha,9 alpha-(epoxymethano)prosta-5↗
Age-related decreases in chromium levels in 51,665 hair, sweat, and serum samples from 40,872 patients--implications for the prevention of cardiovascular disease and type II diabetes mellitus.
This report shows, for the first time using modern analytical techniques, highly significant age-related decreases in chromium levels in 51,665 hair, sweat, and serum samples obtained from 40,872 patients referred by their physicians to an independent medical research clinic and laboratory (r = -.598 to -.762, P < .0001 for all correlations). Males were found to have significantly lower mean chromium levels than females (P < .05 to .0001). There was good correlation between chromium levels in hair, sweat, and serum (r = .536 to .729, P < .0001 for all correlations), indicating that hair and sweat chromium levels are valid additions to the serum levels in assessing chromium status. Chromium measurements in sweat, hair, and serum were performed using graphite furnace atomic absorption spectrophotometry. The influences that age-related decreases in chromium levels might have on increasing the risk to develop age-related impaired glucose metabolism, disordered lipid metabolism, coronary heart disease, arteriosclerosis, and type II diabetes mellitus are outlined, and the role that refined carbohydrates play in the development of compromised chromium status is presented.
Adolescent↗
A survey of community placements for educational programmes in nursing and midwifery.
In this paper preliminary findings from the first stage of an English National Board (ENB) commissioned study investigating the educational needs of community practitioners in relation to their responsibilities for student learning are presented. A national postal survey of all educational centres offering nurse and/or midwifery education was undertaken in the latter half of 1993. Information was collected regarding the nature and planning of the community practice components of courses. The main methods of support for practitioners included the provision of the ENB 998/997 courses and liaison meetings between educational centres and community practice areas. Practitioners were often required to both supervise and assess students on practice placements, the length of these placements varying enormously. For those centres offering the mental health and learning disability branches of the Diploma in Higher Education in Nursing Studies (Project 2000), a significant proportion lacked teachers with specialist community qualifications. The investigation took place at a time of great upheaval, with 42% of centres reporting that they were in the process of amalgamation. The findings demonstrate that community nurses and midwives undoubtedly contribute to the education of nurse and midwife students and consequently have educational needs which must be addressed if they are to continue to supervise students.
Community Health Nursing↗
Quantitative analysis of ammonia on the breath of patients in end-stage renal failure.
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Adult↗
Promoting autonomy and independence for older people within nursing practice: a literature review.
The principles of promoting autonomy and independence underpin many approaches to improving the quality of nursing care for older people in whatever setting, and are in line with wider developments in health care such as the Patient's Charter. However, these concepts require careful definition if nursing practices which might promote autonomy and independence are to be identified. Although the generalizability of the research-based literature in this field is limited by a focus upon older people in continuing-care settings, a review of the literature found a number of indicators associated with attempts to promote patient autonomy and independence. These were grouped into the following categories: systems of care delivery which promote comprehensive individualized assessment and multidisciplinary care planning; attempts to encourage patients/clients to participate in decisions about their care; patterns of communication which avoid exerting power and control over patients/clients and attempts to modify the environment to promote independence and minimize risk. It is suggested that the review identifies a number of principles for nursing practice which can be applied in a range of care settings in order to promote the autonomy and independence of older people.
Activities of Daily Living↗
Post-transfusion purpura (PTP) associated with anti-HPA-1a, anti-HPA-2b and anti-HPA-3a antibodies.
The serum from an 85-year-old man with a clinical diagnosis of post-transfusion purpura (PTP) was investigated for the presence of platelet-specific antibodies. Clinically, the case was typical of PTP but, unusually, the serum was found to contain multiple platelet-specific alloantibodies. Anti-HPA-1a, anti-HPA-2b and anti-HPA-3a antibodies were detected together with multispecific anti-HLA (class I) antibodies. Additional (but weaker) antibody reactivity was also observed with platelet glycoproteins (Gp) IIb/IIIa, GpIb and GpIa/IIa which lacked the antigens recognized by the alloantibodies, suggesting the presence of auto- or cross-reacting antibodies. The patient's genotype was HPA-1b/1b, HPA-2a/2a, HPA-3b/3b, HPA-5a/5b and was consistent with the platelet alloantibodies detected. The patient made a complete recovery following treatment with intravenous gamma-globulin.
Aged↗
The course of alcohol withdrawal in a general hospital.
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Anti-Anxiety Agents↗
Comparison of methods for the isolation of methicillin resistant Staphylococcus aureus.
The control of methicillin resistant Staphylococcus aureus (MRSA) relies on the rapid and sensitive detection of carriage. The roles of an enrichment broth, duration of incubation, and Baird-Parker medium containing ciprofloxacin (BPC) were evaluated in comparison with standard media in a centre where the prevalence of ciprofloxacin resistance among MRSA is over 98%. Screening swabs from 402 sites were plated onto BPC, mannitol salt agar (MSA), and MSA with methicillin (MMSA). The swabs were enriched in Tryptone-T broth with 6% salt for 24 hours and the broths subcultured onto BPC, MSA, and MMSA. MRSA was isolated from 134 swabs. Significantly more isolates were obtained by incubating culture plates for 42 hours rather than 18 hours, by the use of broth enrichment, and by addition of methicillin or ciprofloxacin to media. BPC was the most sensitive medium (107 isolates (80%) by direct culture at 42 hours), grew the fewest contaminants, and allowed provisional reporting of 73% of isolates at 18 hours by colonial appearance and use of Staphaurex Plus rapid latex reagent. This may allow the introduction of infection control measures a day earlier than when other established methods are used.
Bacteriological Techniques↗
Cost effectiveness of medical ethics training.
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Cost-Benefit Analysis↗
Changes in self-reported dental anxiety in New Zealand adolescents from ages 15 to 18 years.
Little is understood of the natural history of dental anxiety. The aim of this study was to examine three-year changes in self-reported dental anxiety among adolescent participants in the Dunedin Multidisciplinary Health and Development Study. Dental anxiety was estimated at ages 15 and 18 by means of the Corah Dental Anxiety Scale (DAS). A DAS score of 13+ defined high dental anxiety. Participants were assigned to one of four dental-anxiety study groups (Chronic, Incident, Remitted, or Never) on the basis of changes in reported level of anxiety from ages 15 to 18. Results are reported for the 691 participants who completed the DAS at both ages. The sample's overall dental anxiety score decreased significantly from age 15 (mean, 8.79) to 18 (8.52) (paired t test, t = 2.37; P < 0.05). The Chronic and Never groups had small negative DAS increments, the Incident group showed a substantial positive increment, and the Remitted group recorded an even larger negative increment. Multivariate analysis showed that the DAS score at age 15 was the sole predictor of the change in DAS score for the Chronic and Remitted groups, and was a co-predictor for the Incident and Never groups. An episodic dental visiting pattern was a strong predictor of a positive change in DAS score for the Incident group; and for the Never group, a higher DMFS score at age 15 predicted a positive change in DAS score at 18, but being female was predictive of a decrement. This study indicates lower stability of dental anxiety in late adolescence than has been reported from other age groups.
Adolescent↗