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Biomedical subjects

C Del Mar

Publications and source records attributed to C Del Mar.

At least 19 recordsLinked to original sources
PubMed2001

Tryptophan and 5-hydroxytryptophan for depression.

BACKGROUND: 5 Hydroxytryptophan (5-HTP) and tryptophan are so-called natural alternatives to traditional antidepressants, used to treat unipolar depression and dysthymia. OBJECTIVES: To determine whether 5-HTP and tryptophan are more effective than placebo, and whether they are safe to use to treat depressive disorders in adults. SEARCH STRATEGY: Trials were searched in computerized general (Medline, Psychlit, and Embase) and specialized databases (Cochrane Controlled Clinical Trials Register, Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trial Register); by checking reference lists of relevant articles; by handsearching relevant specialist journals; and by contacting relevant authors where appropriate. Publications in all languages were sought. SELECTION CRITERIA: Trials were included if they were randomized, included patients with unipolar depression or dysthymia, compared preparations of 5-HTP or tryptophan with placebo, and included clinical outcomes assessed by scales assessing depressive symptoms. DATA COLLECTION AND ANALYSIS: Data was extracted independently by the three reviewers, onto data collection forms. Inclusion criteria were applied to all potential studies independently and a coefficient of agreement (Kappa) was calculated for them. Disagreement was resolved by reaching consensus. Trial quality was scored according to risk of bias. Analysis for 5-HTP and tryptophan were combined due to the small number of included trials. MAIN RESULTS: 108 trials were located using the specified search strategy. Of these, only two trials, involving a total of 64 patients, were of sufficient quality to meet inclusion criteria. The available evidence suggests these substances were better than placebo at alleviating depression (Peto Odds Ratio 4.10; 95% confidence interval 1.28-13.15; RD 0.36; NNT 2.78). However, the evidence was of insufficient quality to be conclusive. REVIEWER'S CONCLUSIONS: A large number of studies appear to address the research questions, but few are of sufficient quality to be reliable. Available evidence does suggest these substances are better than placebo at alleviating depression. Further studies are needed to evaluate the efficacy and safety of 5-HTP and tryptophan before their widespread use can be recommended. The possible association between these substances and the potentially fatal Eosinophilia-Myalgia Syndrome has not been elucidated. Because alternative antidepressants exist which have been proven to be effective and safe the clinical usefulness of 5-HTP and tryptophan is limited at present.

5-Hydroxytryptophan↗
PubMed2000

Predictors of an antibiotic prescription by GPs for respiratory tract infections: a pilot.

BACKGROUND: Antibiotics are over-prescribed for respiratory tract infections in Australia. OBJECTIVES: The aim of this study was to describe the clinical predictors of GPs' prescribing of antibiotics. METHODS: We used Clinical Judgment Analysis to study the responses of GPs to hypothetical paper-based vignettes of a 20-year-old with a respiratory tract infection. The nature of four symptoms and signs (colour of nasal mucous discharge; soreness of the throat; presence of fever; and whether any cough was productive of sputum) was varied and their effect on prescribing measured using logistic regression. RESULTS: Twenty GPs participated. The nature of each symptom and sign significantly predicted prescribing of an antibiotic. Cough productive of yellow sputum; presence of sore throat; fever; and coloured nasal mucus increased the probability of an antibiotic being prescribed. CONCLUSIONS: GPs are influenced by clinical signs and symptoms to use antibiotics for respiratory infections for which there is poor evidence of efficacy from the literature.

Adult↗
PubMed2000

Socio-demographic correlates of screening intention for colorectal cancer.

OBJECTIVE: To assess the relationship between socio-demographic factors and screening intention for colorectal cancer (CRC). METHODS: A cross-sectional survey of a random sample of 884 Queenslanders aged 40-80 years was conducted using a computer-assisted telephone interviewing system. The factors measured included socio-demographic characteristics, personal history of CRC, knowledge of others with CRC and perceived symptom status. Chi-squared and Monte Carlo estimates of Fisher Exact Tests were performed to determine the associations between socio-demographic factors and screening intention. In multivariate analyses, multinomial logistic regression (MNLR) was utilised to examine potential determinants of screening intention. RESULTS: 77.5% (95% CI 74.0%-80.7%) of the respondents indicated their intention to participate in CRC screening if it were recommended by their doctor or health authorities. The likelihood ratio chi-squared tests in the MNLR analyses show that age (chi(df = 6)2 = 15.0; p = 0.02), education (chi(df = 8)2 = 19.4; p = 0.01), perceived symptom status (chi(df = 4)2 = 22.9; p = 0.00), sex (chi(df = 2)2 = 4.5; p = 0.11), income (chi(df = 14)2 = 19.6; p = 0.14) and personal history of CRC (chi(df = 2)2 = 4.3; p = 0.12) were potential determinants of screening intention. Other socio-demographic factors, including country of birth, private health insurance status, Socio-economic Index for Areas, and Rural and Remote Areas Classification codes, were not associated with screening intention. CONCLUSIONS AND IMPLICATIONS: The results indicate that a variety of socio-demographic factors are associated with screening intention and need to be considered in the future development of a population-based screening program for CRC.

Adult↗
PubMed2000

How effective are treatments other than antibiotics for acute sore throat?

To estimate the benefits of treatments other than antibiotics for acute sore throat, and the differences between non-antibiotic interventions and controls in patient-perceived pain of sore throat, a systematic review of controlled trials in Medline and the Cochrane Library was carried out. Sixty-six randomised controlled trials (with or without additional antibiotics) were identified and 17 met the selection criteria. Twenty-two non-antibiotic managements for sore throat were compared. Their efficacy relative to placebo ranged from no effect to 93%. Some non-antibiotic treatments may be more effective than antibiotics; however, publication bias may have exaggerated the benefits. These treatments should be investigated further with respect to efficacy, safety, and side-effects as potential firstline management options for acute sore throat.

Acetaminophen↗
PubMed1999

Bed rest: a potentially harmful treatment needing more careful evaluation.

BACKGROUND: Bed rest is not only used in the management of patients who are not able to mobilise, but is also prescribed as a treatment for a large number of medical conditions, a procedure that has been challenged. We searched the literature for evidence of benefit or harm of bed rest for any condition. METHODS: We systematically searched MEDLINE and the Cochrane library, and retrieved reports on randomised controlled trials of bed rest versus early mobilisation for any medical condition, including medical procedures. FINDINGS: 39 trials of bed rest for 15 different conditions (total patients 5777) were found. In 24 trials investigating bed rest following a medical procedure, no outcomes improved significantly and eight worsened significantly in some procedures (lumbar puncture, spinal anaesthesia, radiculography, and cardiac catheterisation). In 15 trials investigating bed rest as a primary treatment, no outcomes improved significantly and nine worsened significantly for some conditions (acute low back pain, labour, proteinuric hypertension during pregnancy, myocardial infarction, and acute infectious hepatitis). INTERPRETATION: We should not assume any efficacy for bed rest. Further studies need to be done to establish evidence for the benefit or harm of bed rest as a treatment.

Bed Rest↗
PubMed1999

Psychologic distress in women with abnormal findings in mass mammography screening.

BACKGROUND: This study was conducted to explore the psychologic morbidity of women recalled for diagnostic assessment during population-based mammographic screening. METHODS: This study prospectively attempted to measure physical, social, and emotional well-being by the administration of a questionnaire before screening, at the time of recall; and 1 month later to women recalled and matched women with those not recalled. RESULTS: Of the 224 women who were recalled for further diagnostic assessment and their matches, complete follow-up was obtained on 182 pairs (81.3%). In contrast to those women not recalled, recalled women exhibited increased levels of concern at the time of recall. These levels had not decreased to the initial level after 1 month, even though breast carcinoma was not diagnosed. Similar negative short term effects also were evident in the areas of physical well-being, social functioning, and anxiety and insomnia levels, although these were not sustained. CONCLUSIONS: Women with normal results after mass mammographic breast screening experienced no increase in psychologic distress and a decrease in their concern regarding breast carcinoma. However, those women who were recalled to follow-up after abnormal findings experienced an increase in their level of concern regarding breast carcinoma and this concern was sustained, as determined by repeat questionnaire, 1 month after a negative result had been determined.

Adaptation, Psychological↗
PubMed1999

Nursing's contribution to general practice: general practitioners' and practice nurses' views.

This study was instigated by the paucity of knowledge relating to the work of nurses employed by general practitioners in Australia and the phenomenal development of the practice nurse role in the United Kingdom. A mailed survey of general practitioners and practice nurses within one Division of General Practice in South-East Queensland, sought, among other things, their views about the current and potential contribution of nursing to general practice. Eighty-four out of 164 (51%) general practitioners and 37 out of 67 (55%) practice nurses responded to the survey. Results indicated that both general practitioners and practice nurses appreciated the value of nursing services in general practice and would sanction the employment of more nurses especially for the purpose of preventive care. The majority of nurses were agreeable to the notion that the nurse's role could, and should, be expanded to include autonomous functioning while most of the doctors were amenable to some extension of nursing practice but reticent or opposed to any independent interventions.

Attitude of Health Personnel↗
PubMed1999

Women's knowledge about the physical and emotional changes associated with menopause.

In 1992, a survey was undertaken to study women's knowledge of the physical and emotional changes associated with menopause. Two groups of midlife women: a random sample (n = 381) and a sample of women who attended menopause seminars (n = 95) were asked to select from a list of 39 changes those they thought were directly caused by menopause. Information from readily available books written for a general audience was used to construct the marking guide for a "commonly available knowledge" score. A template for a "biomedical" knowledge score based on an estrogen deficiency perspective of menopause was derived from recently published academic medical literature. The mean score for the commonly available knowledge items was 27 out of 39 (69.2% correct). The mean biomedical knowledge score was lower, 19.3 out of 35 (55.1% correct). While the two groups of women were significantly different in terms of current and past hormone replacement therapy (HRT) use, we found no differences between them in the mean commonly available knowledge or biomedical knowledge scores. This finding challenges the widely held assumption that active information-seekers are more interested and have a better level of knowledge than the general population. The findings also suggest that women are less likely to accept a biomedical model of menopause and that they are using HRT for a multiplicity of reasons, not just those related to estrogen deficiency.

Estrogen Replacement Therapy↗
PubMed1998

Do personalised letters in Vietnamese increase cervical cancer screening among Vietnamese women?

In Australia, Vietnamese women are at greater risk of cervical cancer than other Australian women. To increase their participation in cervical screening, the Vietnamese community was exposed to a media campaign about the advantages of cervical smear screening which was delivered in Vietnamese through Vietnamese newspapers and radio. In addition, 689 Vietnamese (18-67 years) were selected from the electoral roll. They were randomly assigned to either receive a personal letter written in Vietnamese promoting cervical screening, or not. We report on the effect of the letter on smear rates. Being randomised to be sent such a letter was not associated with any increase in screening (relative rate of appropriate screening in the intervention versus the control group was 0.85, 95% CI 0.55-1.3). It is important to carefully evaluate untested health promotion interventions.

Adolescent↗