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Biomedical subjects

C Ball

Publications and source records attributed to C Ball.

At least 37 records · Page 2Linked to original sources
PubMed2002

Adult attachment style. II: Its relationship to psychosocial depressive-vulnerability.

BACKGROUND: A range of studies show adult attachment style is associated with depressive-vulnerability factors such as low self-esteem, poor support and childhood adversity. However, there is wide inconsistency shown in the type of insecure style most highly associated. Few studies have examined attachment style in relation to clinical depression together with a range of such factors in epidemiological series. The present study uses an interview measure of adult attachment which differentiates type of attachment style and degree of insecurity of attachment, to see: (a) if it adds to other vulnerability in predicting depression and (b) if there is specificity of style to type of vulnerability. METHOD: Two hundred and twenty-two high-risk and 80 comparison women were selected from questionnaire screenings of London GP patient lists and intensively interviewed. The Attachment Style Interview (ASI) differentiated five styles (Enmeshed, Fearful, Angry-dismissive, Withdrawn and Standard) as well as the degree to which attitudes and behaviour within such styles were dysfunctional ('non-standard'). Attachment style was examined in relation to low self-esteem, support and childhood experience of neglect or abuse, and all of these examined in relation to clinical depression in a 12-month period. RESULTS: The presence of any 'non-standard' style was significantly related to poor support, low self-esteem and childhood adversity. Some specificity of type of style and type of vulnerability was observed. Logistic regression showed that non-standard Enmeshed, Fearful and Angry-dismissive styles, poor support and childhood neglect/abuse provided the best model for clinical depression. CONCLUSION: Non-standard attachment in the form of markedly Enmeshed, Fearful or Angry-dismissive styles was shown to be associated with other depressive-vulnerability factors involving close relationships, self-esteem and childhood adversity and added to these in modelling depression.

Adult↗
PubMed2002

Paediatric antiretroviral therapy audit in South London.

OBJECTIVES: To audit clinical and surrogate marker outcome data following the introduction of combination antiretroviral therapy to HIV-infected children in South London. METHODS: We performed a retrospective cohort study of 110 HIV-infected children under the care of the Paediatric HIV in South London Network (PHILS-NET) from January 1996 to September 1999. The following were identified: type of antiretroviral therapy used; duration of therapy; toxicity; impact on viral load and CD4 count; reasons for changing therapy; and clinical progression. RESULTS: Ninety-one (83%) of the 110 children (55 females; median age 6.3 years) received 166 antiretroviral therapy regimens. Sixty per cent of the regimens were triple therapy: either two nucleoside reverse transcriptase inhibitors (NRTIs) and one protease inhibitor (58; 34.9%) or two NRTIs and one non-nucleoside reverse transcriptase inhibitor (39; 23.5%). The mean duration of completed therapy was 46 weeks for first line therapy with a standard deviation (SD) of 38 weeks and 40 weeks in third line therapy with an SD of 22 weeks. Changes in antiretroviral regimens were owing to virological failure in 60% and toxicity in 10%. Overall, 46% of children on first line and 37% on second line antiretroviral therapy achieved an undetectable viral load of < 400 HIV-1 RNA copies/mL. Clinical progression for the whole cohort fell from 3.7% per year for children on dual therapy to 0.7% per year for children on highly active antiretroviral therapy. CONCLUSIONS: This audit shows the clinical benefit of antiretroviral therapy use in a cohort of children with moderately advanced HIV disease. The surrogate outcome data seen for the viral load and CD4 count are similar to those of reports from clinical trials. Antiretroviral therapy regimens were sequenced rapidly, mainly owing to virological failure.

Adolescent↗
PubMed2002

Childhood adversity, parental vulnerability and disorder: examining inter-generational transmission of risk.

BACKGROUND: An investigation of intergenerational factors associated with psychiatric disorder in late adolescence/early adulthood was undertaken to differentiate influences from maternal disorder, maternal poor psychosocial functioning and poor parenting, on offspring. METHOD: The sample comprised an intensively studied series of 276 mother-offspring pairs in a relatively deprived inner-city London area with high rates of lone parenthood and socio-economic disadvantage. The paired sample was collected over two time periods: first a consecutively screened series of mothers and offspring in 1985-90 (n = 172 pairs) and second a 'vulnerable' series of mothers and offspring in 1995-99 (n = 104 pairs). The vulnerable mothers were selected for poor interpersonal functioning and/or low self-esteem and the consecutive series were used for comparison. Rates of childhood adversity and disorder in the offspring were examined in the two groups. Maternal characteristics including psychosocial vulnerability and depression were then examined in relation to risk transmission. RESULTS: Offspring of vulnerable mothers had a fourfold higher rate of yearly disorder than those in the comparison series (43% vs. 11%, p < .001). They were twice as likely as those in the comparison series to have experienced childhood adversity comprising either severe neglect, physical or sexual abuse before age 17. Physical abuse, in particular, perpetrated either by mother or father/surrogate father was significantly raised in the vulnerable group. Analysis of the combined series showed that maternal vulnerability and neglect/abuse of offspring provided the best model for offspring disorder. Maternal history of depression had no direct effect on offspring disorder; its effects were entirely mediated by offspring neglect/abuse. Maternal childhood adversity also had no direct effect. CONCLUSIONS: Results are discussed in relation to psychosocial models of risk transmission for disorder. Maternal poor psychosocial functioning needs to be identified as a factor requiring intervention in order to stem escalation of risk across generations.

Adolescent↗
PubMed2001

Alagille syndrome associated with angiographic moyamoya.

We describe the case of a 13-year-old boy with Alagille syndrome in whom intracranial imaging was performed following a seizure. The MRI and MRA revealed changes of angiographic moyamoya within both the anterior and posterior circulation. This very rare manifestation of the systemic vasculopathy in Alagille syndrome has not been previously documented in a patient without a focal neurological deficit. We discuss the potential role of routine intracranial imaging in patients with Alagille syndrome.

Alagille Syndrome↗
PubMed2001

Clinical guidelines for the use of the prone position in acute respiratory distress syndrome.

The mortality associated with acute respiratory distress syndrome (ARDS) remains high. It has been suggested that use of the prone position may improve survival. However, approaches to the use of the position are often haphazard. The development of clinical guidelines indicating the need for the prone position in ARDS and the process by which the manoeuvre may be performed were thought to be important for two reasons. Primarily, we sought to improve oxygenation through the use of the prone position whilst promoting patient safety. Secondly, we wished to standardize our approach to the use of the prone position and make recommendations for practice so that its use was no longer seen as a last resort in the management of ARDS. The process associated with the development of clinical guidelines is first described. This is followed by presentation of the clinical guidelines. Included in these are the criteria and discussion which indicate consideration of the prone position, potential exclusion criteria, pre-turn considerations, the turning technique, monitoring the effectiveness of the prone position, passive movements and limb positioning and, finally, documentation of the problems associated with use of the prone position. The paper concludes with discussion concerning the potential for future research in this area.

Algorithms↗
PubMed2001

Hospital-acquired bacteraemia--surveillance and guidelines for practice.

In the Surveillance Report, bacteraemia was not defined specifically within the document. However, it was implied that bacteraemia was present if blood cultures were positive. No clinical information concerning the effect of bacteraemia on the patients or the degree of haemodynamic support required was described. Nor was the movement of patients between specialties indicated. This information would have been helpful to clinicians because it would demonstrate the increased severity of illness experienced by patients and the concomitant increase in services required to meet these needs, although of course prevention should be the key response to the data provided. It is evident from the two reports that infection of the bloodstream is described utilizing different terms, i.e. bacteraemia and catheter-related bloodstream infection. This is potentially confusing and efforts should be made to encourage the use of consistent terminology across specialties, e.g. infection control, critical care, oncology The potential for confusion also arises where evidence is pooled utilizing both CRI and CR-BSI as endpoints for the research reviewed. The recommendation associated with flushing the CVC with heparinized saline solution does not consider a patient's coagulopathy to be a contraindication, only the manufacturer's recommendations. This appears to be a limitation of the guidelines and may place the patient at risk. The recommendation also does not indicate if this is only to be performed when the catheter or lumen is not in use, or if heparin should be administered if it is in use. Finally, the categories used to denote the level of evidence are not defined in the document. It can be assumed that Category 1 relates to randomized controlled trials, which demonstrate homogeneity or/and narrow confidence intervals; whilst categories 2 and 3 relate to cohort studies and pooled data. It should be expected that a document of this nature should establish criteria or refer the reader to the primary source for categorization. Eggimann and Pittet (2000) have undertaken an excellent review of central venous catheter related infections in intensive care units. The evidence accrued and recommendations made mirrors the two reports outlined above. It is imperative we take action to reduce the incidence of CR-BSI and it is hoped that this Editorial has provided a basis for discussion and action; and will stimulate debate.

Bacteremia↗
PubMed2001

Gliomatosis cerebri: pitfalls in diagnosis.

We report two young patients with obscure presentations of gliomatosis cerebri. Initial CT scanning was inconclusive and in one case showed intraventricular haemorrhage, a feature not previously described. Magnetic resonance imaging was required to show the lesions with greater definition; however, in both cases, a biopsy was needed to confirm the diagnosis.

Adult↗
PubMed2001

Predicting onset of depression: the Vulnerability to Depression Questionnaire.

OBJECTIVES: The development of a self-report questionnaire capable of assessing cognitive and interpersonal vulnerability factors for clinical depression is described. The Vulnerability to Depression Questionnaire (VDQ) was developed to provide a brief, economical alternative to the Self-Evaluation and Social Support interview (SESS; O'Connor & Brown, 1984), assessing negative evaluation of self, negative interaction with partner or child and lack of a support figure. DESIGN: The VDQ was tested in a prospective study of community-based women who were contacted on three occasions over the course of approximately 1 year, to: (i) compare the VDQ's capacity to categorize vulnerability compared with the SESS interview, and (ii) to test the VDQ's prediction of onset of clinical depression during the follow-up. METHOD: Selected nondepressed respondents completed the VDQ and were interviewed to determine their vulnerability using the SESS. They were re-interviewed on two further occasions during the follow-up period, and the VDQ was also re-administered at the time of first follow-up. Onset of clinical depression during the follow-up was assessed by interview at each contact. RESULTS: Comparison of VDQ and SESS interview classification of participants' vulnerability at first contact indicated that the questionnaire had good sensitivity and specificity. Test-retest scores for the VDQ indicated satisfactory levels of reliability. VDQ scores also predicted onset of clinical depression in the follow-up period. CONCLUSIONS: Results suggest that the VDQ is an economical and effective means of screening large populations for the purposes of risk assessment, to aid future research into clinical depression and to facilitate the implementation of intervention strategies.

Adolescent↗
PubMed2001

Rat interleukin-10: production and characterisation of biologically active protein in a recombinant bacterial expression system.

Interleukin-10 is an anti-inflammatory Th1 immunosuppressive cytokine, the active form of which is a non-covalent homodimer, and which exhibits species-specificity both with respect to structure and biological activity. The rat homologue of IL-10 shares 73% identity with human IL-10 at the amino-acid sequence level, and has, in addition to the two disulphide bonds present in human IL-10, a fifth, unpaired cysteine (cys-149). Preparation of rat IL-10 by bacterial expression followed by solubilisation and refolding in a glutathione redox system, results in a molecule in which cys-149 is almost entirely oxidised, existing either as disulphide dimer or as a mixed disulphide with glutathione, and which has less than 1% of the activity of the native (cys-149-SH) form of the molecule. Site directed mutagenesis of rat IL-10 to replace cys-149 with tyrosine produces a molecule which readily adopts the active conformation upon solubilisation and refolding, and which is recoverable in good yield from bacterial expression systems. Comparison of the biological activities of rat IL-10tyr149 and commercial rat IL-10 preparations confirms that the activity of native-sequence rat IL-10 is either reduced or absent. It is proposed therefore that the biosynthetic analogue rat IL-10tyr149 is a more useful molecule to investigate the biological actions of IL-10 in the rat.

Animals↗
PubMed2001

Characteristics of general practices involved in undergraduate medical teaching.

BACKGROUND: The movement of medical education into the community has accelerated the development of a new model of general practice in which core clinical services are complemented by educational and research activities involving the whole primary care team. AIM: To compare quality indicators, workload characteristics, and health authority income of general practices involved in undergraduate medical education in east London with those of other practices in the area and national figures where available. DESIGN OF STUDY: A comprehensive survey of undergraduate and postgraduate clinical placements and practice-based research activity within general practice. SETTING: One-hundred and sixty-one practices based in East London and the City Health Authority (ELCHA). METHOD: Cross-sectional survey comparing routinely-collected information on practice resources, workload, income, and performance between teaching and non-teaching practices. RESULTS: In east London, teaching practices are larger partnerships with smaller list sizes, higher staff costs, and better quality premises than non-teaching practices. Teaching practices demonstrate significantly better performance on quality indicators, such as cervical cytology coverage and prescribing indicators. Patient-related health authority income per whole time equivalent (WTE) general practitioner (GP) is significantly lower among teaching practices. A multiple regression analysis was used to explore the association between teaching status and income. Eighty-eight per cent of the variation in patient-related income could be explained by the combination of list size, list turnover, removals at doctor's request, quality of premises, and immunisation and cytology rates. CONCLUSION: This study demonstrates that practice involvement in undergraduate education in east London is associated with higher scores on a range of organisational and performance quality indicators. The lower patient-related income of teaching practices is associated with smaller list sizes and may only be partially replaced by teaching income. Lower vacancy rates suggest that teaching practices are more attractive to doctors seeking partnerships in east London.

Education, Medical, Graduate↗