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Biomedical subjects

D M Foreman

Publications and source records attributed to D M Foreman.

At least 19 recordsLinked to original sources
PubMed2006

Attention deficit hyperactivity disorder: legal and ethical aspects.

Attention deficit-hyperactivity disorder (ADHD) remains a controversial disorder, despite it now being a well validated clinical diagnosis. Ethical and legal issues are important in determining how doctors should behave in offering a diagnosis or treatment that may generate strong and unpredictable reactions from children, their families, or other agencies. A model for routine ethical practice was proposed, based on three sets of assumptions. Firstly, that ethical practice is consistent with the four principles of beneficence, non-maleficence, justice, and respect for autonomy. Secondly, ethical concerns lead to legal processes, whose task is to ensure ethical practice. Thirdly, that we are working in the interests of our patients. Current relevant literature was organised in terms of this model, and recommendations for practice derived from it. Though there is no general ethical problem regarding either the routine diagnosis or treatment of ADHD, ethical difficulties surround some special cases, especially when doctors are working in conjunction with other agencies or coping with non-medical frameworks. Particular care needs to be taken with confidentiality and consent, the limits of which are currently confused. The model worked well with everyday ethical problems, though more difficult cases required careful individual scrutiny.

Attention Deficit Disorder with Hyperactivity↗
PubMed2005

The association between hyperkinesis and breakdown of parenting in clinic populations.

BACKGROUND: There is increasing recognition that child based, as well as parent based factors may be associated with children being excluded from their families. Despite the distress routinely observed among the parents of hyperactive children, there is little research on this in clinic populations. AIMS: To examine removals from home in a typical secondary care population, where hyperkinesis was accurately diagnosed. METHODS: A total of 201 cases were coded using mulitaxial ICD-10 criteria and Jarman indices derived from census data. RESULTS: Hyperkinetic children were more than three times more likely to have suffered removal from home than children with other psychiatric diagnoses, independent of any psychosocial measure. CONCLUSION: Hyperkinesis is a specific risk factor for removal from home, which can operate in the absence of other psychosocial stressors. Screening children for hyperactivity is now simple, and the routine paediatric examination for children accommodated by the local authority gives an opportunity for early detection and treatment of hyperactivity in children at risk of family breakdown.

Child↗
PubMed2003

How should we measure social disadvantage in clinic settings?

BACKGROUND: Despite a large research literature supporting their validity, deprivation indices derived from census data have not been routinely applied to clinic populations. METHOD: A case-note sample of 201 cases was examined, to identify whether such data (Jarman indices) predicted presenting disability separately from diagnostic class (behaviour, emotional, mixed, other, and no diagnosable disorder), or conventional clinic measures of social adversity (ICD-10 psychosocial diagnostic codes). RESULTS: Jarman index scores predicted disability in behaviour disorders or other disorders. Conventional clinic measures of adversity predicted disability in mixed disorders. For emotional disorders, and those cases with no diagnosed disorder, clinically measured adversity and Jarman scores interacted. CONCLUSIONS: Postcode related census data capture information about clinic children's presenting disability that is not available from routine clinic assessment of psychosocial adversity. It should therefore be collected as part of the routine clinical child psychiatry assessment.

Adolescent↗
PubMed2001

Is clinic prevalence of ICD-10 hyperkinesis underestimated? Impact of increasing awareness by a questionnaire screen in an UK clinic.

Hyperactivity is common, but its diagnosis is still controversial, with two contending approaches: ADHD from DSM IV and hyperkinesis from ICD-10. The concept of ADHD predicts higher rates, but its use may lead to overmedication. Hyperkinesis usefully indicates medication, but clinics using it may detect many fewer cases, raising the possibility of underdiagnosis. It has never been shown whether this lower rate results from hyperkinesis' criteria, or to the differing methods used to detect hyperactivity in those centres that prefer it. We report a mirror study, examining rates of all types of hyperkinesis before and after the introduction of a preliminary screen (not originally intended to detect hyperkinesis). Its introduction resulted in an increase of detected hyperkinesis from 2% to 25% of the clinic sample with no change in diagnostic criteria. This was independent of any other change in the sample or clinic staff. We conclude that insensitive assessment may be responsible for low rates of diagnosis of ICD-10 hyperkinesis in secondary care clinics.

Affective Symptoms↗
PubMed2000

Infant psychiatry--its scope, coherence and clinical utility.

BACKGROUND: Infant psychiatry claims to be a separate discipline within psychiatry. This article sets out to test that claim. Goals were to establish whether the field had meaningful boundaries; whether its practice related to a coherent body of research; and whether its assessments and syndromes had clinical utility. METHODS: A descriptive, conceptually based review of the literature was undertaken. Established opinion was taken from authoritative textbooks and reviews, and compared with other articles from both keyword and citation-based literature searches. RESULTS: Infant psychiatry is defined by three components. It focuses on children young enough to be socially absorbed primarily in the relationship with their main caretaker. It privileges these relationships, attempting to predicate psychopathology and treatment upon them. It then applies this basis to specific syndromes, their assessment and treatment. This approach has been conceptually and practically effective. Limitations include inadequate distinctions between the normal range of individual differences and psychopathology, and poor integration of constitutional hypotheses about infant difficulties. CONCLUSIONS: Infant psychiatry can support its claim to be a separate discipline, with an approach that is both distinctive and useful. Further advances in the field would benefit from collaborative research that would expand its interactionist perspective, and link differences to psychopathology.

Child Psychiatry↗
PubMed1999

The family rule: a framework for obtaining ethical consent for medical interventions from children.

Children's consent to treatment remains a contentious topic, with confusing legal precepts and advice. This paper proposes that informed consent in children should be regarded as shared between children and their families, the balance being determined by implicit, developmentally based negotiations between child and parent--a "family rule" for consent. Consistent, operationalized procedures for ethically obtaining consent can be derived from its application to both routine and contentious situations. Therefore, use of the "family Rule" concept can consistently define negligent procedure in obtaining consent from children, and could be used as a unifying framework in the development of new professional guidelines. A "guideline"-based approach to children's consent to treatment may offer greater individuality than a "rights"-based approach, though careful training and oversight will be needed for it to be effective.

Beneficence↗
PubMed1997

Emotional and semantic priming as a measure of information processing in young people with school refusal: a research note.

We investigated semantic and emotional priming of lexical decision-making in 20 school refusers and 20 attenders aged 11-16 years, matched for sex and reading ability. We hypothesised that: semantic and emotional priming would be demonstrable in both samples; and that the school refusers would show emotional priming of school-related words to aversive primes. Both samples showed semantic priming; emotional priming was shown by the attenders and 11 school refusers without a history of depression. School-refusing children did not show emotional priming for school-related words. Nine school-refusing children with either current or past depression showed a general reduction in their priming. These results show that both semantic and emotional priming can be detected in this age-range. They do not support school refusal being typically associated with anxiety about school. The reduction in priming in those with a depressive history is similar to inhibition in information processing in depressed adults. Priming is therefore sensitive to at least some psychiatrically relevant states or traits in this age-range. It is concluded that priming could be a useful measure of information processing in this age-group, and further research is warranted.

Adolescent↗
PubMed1996

A simple organ culture model for assessing the effects of growth factors on corneal re-epithelialization.

The effects of growth factors on re-epithelialization of wounded human and bovine corneas were studied in a simple organ culture system. Excisional trephine and epithelial scrape wounds were created on bovine and human corneo-scleral rings in which the endothelial corneal concavity was then filled with an agar-collagen mixture. Organ culture was undertaken at 37 degrees C in a humidified 5% CO2 incubator with serum-free Medium 199 maintained at the level of the conjunctival epithelium. Rates of reepithelialization in response to addition of exogenous epidermal growth factor (EGF), basic fibroblast growth factor (bFGF) and transforming growth factor type beta 1 (TGF-beta 1) were assessed by image analysis. Corneal cultures could be maintained for up to 3 weeks without significant stromal oedema or keratocyte deterioration and with little loss of epithelial architecture. Following wounding the cornea reepithelialized in a similar fashion to that observed in vivo i.e. a lag phase followed by migration/proliferation and the reformation of an intact multilayered epithelium. EGF accelerated, basic FGF had no effect on, and TGF-beta 1 inhibited the rate of corneal re-epithelialization. Our organ culture model maintains corneal integrity and provides a practical system in which to study factors that modulate corneal reepithelialization following wounding.

Animals↗
PubMed1996

Conduct disorder, enuresis and specific developmental delays in two types of encopresis: a case-note study of 63 boys.

Encopresis, defined as the passage of stool in an unacceptable place, may occur either as a failure to establish toilet training (primary encopresis), or as a subsequent breakdown in that training (secondary encopresis). A case-note study of sixty-three encopretic boys was undertaken to test the hypothesis that primary and secondary encopresis differed in their associated psychopathology. Boys with primary encopresis were more likely to have developmental delays (p<0.001) and enuresis (p<0.05) than boys with secondary encopresis. Those with secondary encopresis had excesses of psychosocial adversity (p <0.001) and conduct disorder (p <0.05) compared to those with primary encopresis. These results suggest that future research should clearly distinguish these two subtypes when investigating the associated psychopathology of encopresis in boys; research is needed to establish if these associations hold for girls also.

Child↗
PubMed1996

Three dimensional analysis of the retinal vasculature using immunofluorescent staining and confocal laser scanning microscopy.

AIM: To undertake a qualitative and quantitative analysis in three dimensions of the human retinal vasculature. METHOD: Fixed and excised whole retinas were permeabilised and subjected to immunofluorescent staining for blood vessel components followed by confocal laser scanning microscopy. Single projection and stereoimages were constructed using computer software. XZ sections through the retina were constructed and the vasculature analysed using appropriate software. RESULTS: Immunofluorescent staining with no discontinuities was present in vessels of all sizes, the confocal images of the capillary network being free of out of focus blur at all depths. Quantitative analysis of XZ sections confirmed the qualitative impression of sharp delineation of the deep retinal capillary plexus, an absence of laminar arrangement of capillaries within the inner retina, and a truncated cone of capillaries around the foveal avascular zone (FAZ) wherein the superficial capillaries approached the FAZ more closely than those in the deeper retina. CONCLUSION: Immunofluorescent staining of the retina and confocal laser scanning microscopy were shown to be useful in analysing accurate three dimensional reconstructions of the normal retinal vasculature without affecting overall tissue architecture.

Adult↗
PubMed1996

Dual immunodetection and hybridisation in situ of opsin mRNA and rhodopsin protein in retinal sections.

We describe a simple method for combining in situ hybridisation and immunohistochemistry on the same retinal section. The technique was developed using a radiolabelled cDNA probe for opsin and an antibody (ROS1F4) against rhodopsin. This method retains the antigenic sites if immunocytochemistry is performed prior to in situ hybridisation. Opsin mRNA was found in the photoreceptor inner segment with rhodopsin immunolocalised to the photoreceptor outer segments. The technique should be applicable to numerous situations including analysis of the sequence of events in the expression and synthesis of the various opsins during retinal development and degeneration.

Antibodies, Monoclonal↗
PubMed1996

Homo-erotomania for a delusional parent: erotomania with Capgras and Fregoli syndromes in a young male with learning difficulties.

A 19-year-old male with learning difficulties exhibited erotomania associated with first-rank symptoms of schizophrenia; the subject responded to neuroleptic medication. The love object was a male neighbour believed by the subject to be his father. This is the first recorded case where erotic desire has been coupled with the delusion that the object is also the parent of the sufferer. We propose a multifactorial aetiology, considering the possibility of complex psychodynamics in the presence of learning difficulties.

Adult↗
PubMed1995

Neutralisation of TGF-beta 1 and TGF-beta 2 or exogenous addition of TGF-beta 3 to cutaneous rat wounds reduces scarring.

Exogenous addition of neutralising antibody to transforming growth factor-beta 1,2 to cutaneous wounds in adult rodents reduces scarring. Three isoforms of transforming growth factor-beta (1, 2 and 3) have been identified in mammals. We investigated the isoform/isoforms of TGF-beta responsible for cutaneous scarring by: (i) reducing specific endogenous TGF-beta isoforms by exogenous injection of isoform specific neutralising antibodies; and (ii) increasing the level of specific TGF-beta isoforms by exogenous infiltration into the wound margins. Exogenous addition of neutralising antibody to TGF-beta 1 plus neutralising antibody to TGF-beta 2 reduced the monocyte and macrophage profile, neovascularisation, fibronectin, collagen III and collagen I deposition in the early stages of wound healing compared to control wounds. Treatment with neutralising antibodies to TGF-betas 1 and 2 markedly improved the architecture of the neodermis to resemble that of normal dermis and reduced scarring while the control wounds healed with scar formation. Exogenous addition of neutralising antibody to TGF-beta 1 alone also reduced the monocyte and macrophage profile, fibronectin, collagen III and collagen I deposition compared to control wounds. However, treatment with neutralising antibody to TGF-beta 1 alone only marginally reduced scarring. By contrast, wounds treated with neutralising antibody to TGF-beta 2 alone did not differ from control wounds. Interestingly, exogenous addition of the TGF-beta 3 peptide also reduced the monocyte and macrophage profile, fibronectin, collagen I and collagen III deposition in the early stages of wound healing and markedly improved the architecture of the neodermis and reduced scarring. By contrast, wounds treated with either TGF-beta 1 or with TGF-beta 2 had more extracellular matrix deposition in the early stages of wound healing but did not differ from control wounds in the final quality of scarring. This study clearly demonstrates isoform specific differences in the role of TGF-betas in wound healing and cutaneous scarring. TGF-beta 1 and TGF-beta 2 are implicated in cutaneous scarring. This study also suggests a novel therapeutic use of exogenous recombinant, TGF-beta 3 as an anti-scarring agent.

Animals↗
PubMed1994

Neutralising antibody to TGF-beta 1,2 reduces cutaneous scarring in adult rodents.

Scarring is a major cause of many clinical problems. Scar tissue interferes with growth, impairs function and is aesthetically unpleasant. However, scarring does not appear to be a problem of embryonic life. Embryonic wounds heal with a lower inflammatory and angiogenic response and have a different growth factor profile compared to adult wounds. We have used neutralising antibody to transforming growth factor-beta 1,2 (TGF-beta 1,2) to alter the growth factor profile of cutaneous wounds in adult rodents and studied the effect on scar tissue formation. This paper extends our preliminary report that neutralising antibody to TGF-beta reduces cutaneous scarring in adult rodents. To be effective, the neutralising antibody to TGF-beta needs to be administered at the time of wounding or soon thereafter. The antiscarring effects of this neutralising antibody to TGF-beta were dose dependent. Exogenous addition of neutralising antibody to TGF-beta to incisional wounds reduced the inflammatory and angiogenic responses and reduced the extracellular matrix deposition in the early stages of wound healing without reducing the tensile strength of the wounds. Importantly, the architecture of the neodermis of wounds treated with neutralising antibody to TGF-beta resembled more closely that of normal dermis compared to the unmanipulated control wounds, which healed with an abnormal neodermal architecture resulting in obvious scarring. This study suggests a novel therapeutic approach to reducing scarring in post-natal life.

Animals↗