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David Owens

Publications and source records attributed to David Owens.

At least 19 recordsLinked to original sources
PubMed2005

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Correspondence as Topic↗
PubMed2005

Supporting young people who repeatedly self-harm.

This paper explores the views and experiences of a group of 74 young people aged 16-22 who were interviewed following presentation in accident and emergency (A&E) departments after intentionally harming themselves. It focuses on a sub-group of 38 young people with a history of self-harm behaviour that extended from when they were under the age of 16, one-third of whom had been or were currently in care. Whilst some had kept their self-harming hidden and had not received any professional intervention until they reached adulthood, others had been in touch with services, although their treatment had not prevented them from continuing to self-harm. Medication was perceived as 'fobbing off', particularly when unaccompanied by other treatments. The young people described their encounters with counsellors and clinicians, some of whom they perceived not to understand or to listen to their perspective. Whilst not representative of all young people who self-harm, these views are important and deserve attention if interventions for children and adolescents are to prevent repetition of self-harm.

Adolescent↗
PubMed2005

Mortality and suicide after non-fatal self-poisoning: 16-year outcome study.

BACKGROUND: Suicide reduction is government strategy in many countries. We need to quantify the connection between non-fatal self-poisoning and eventual suicide. AIMS: To determine mortality after an episode of self-poisoning and to identify predictors of death by any cause or by suicide. METHOD: A retrospective single-group cohort study was undertaken with 976 consecutive patients attending a large accident and emergency unit in 1985-1986 after non-fatal self-poisoning. Information about deaths was determined from the Office for National Statistics. RESULTS: Of the original patients, 94% were traced 16 years later; 17% had died, 3.5% by probable suicide. Subsequent suicide was related to numerous factors evident at the time of the episode of self-poisoning but, when examined for their independent effects, only the severity of the self-poisoning episode and relevant previous history seemed important. CONCLUSIONS: Patients attending a general hospital after self-poisoning all require good basic assessment and care responsive to their needs. Attempts to reduce the huge excess of suicide subsequent to self-harm are not likely to achieve much if they are based on the identification of subgroups through'risk assessment'.

Cause of Death↗
PubMed2005

Suction diathermy adenoid ablation.

Adenoidectomy is a surgical procedure frequently carried out in otolaryngological practice, traditionally undertaken blindly with curettage using an adenotome following palpation of the adenoid bed. While a number of alternative methods have been described for surgical removal of the adenoid pad (power-assisted/microdebrider, transnasal adenoid ablation, suction coagulation and liquefaction/aspiration) none has become the definitive procedure. Suction diathermy adenoidectomy has been known and used for some time; it has gained in popularity over recent years and is established as an alternative to conventional curettage, particularly in children. We describe several techniques which improve the view of the surgical field while performing suction diathermy adenoid ablation.

Adenoidectomy↗
PubMed2005

Association between streptococcal infection and obsessive-compulsive disorder, Tourette's syndrome, and tic disorder.

OBJECTIVE: Reports have suggested that streptococcal infection may be etiologically related to pediatric autoimmune neuropsychiatric disorders (PANDAS), but there are few good epidemiologic studies to support this theory. Using population-based data from a large West-Coast health maintenance organization, we assessed whether streptococcal infection was associated with increased risk for obsessive-compulsive disorder (OCD), Tourette's syndrome (TS), or tic disorder. METHODS: This is a case-control study of children 4 to 13 years old receiving their first diagnosis of OCD, TS, or tic disorder between January 1992 and December 1999 at Group Health Cooperative outpatient facilities. Cases were matched to controls by birth date, gender, primary physician, and propensity to seek health care. RESULTS: Patients with OCD, TS, or tic disorder were more likely than controls to have had prior streptococcal infection (OR: 2.22; 95% CI: 1.05, 4.69) in the 3 months before onset date. The risk was higher among children with multiple streptococcal infections within 12 months (OR: 3.10; 95% CI: 1.77, 8.96). Having multiple infections with group A beta-hemolytic streptococcus within a 12-month period was associated with an increased risk for TS (OR: 13.6; 95% CI: 1.93, 51.0). These associations did not change appreciably when limited to cases with a clear date of onset of symptoms or with tighter matching on health care behavior. CONCLUSION: These findings lend epidemiologic evidence that PANDAS may arise as a result of a postinfectious autoimmune phenomenon induced by childhood streptococcal infection.

Adolescent↗
PubMed2004

Postprandial glucose regulation and diabetic complications.

Atherosclerotic disease accounts for much of the increased mortality and morbidity associated with type 2 diabetes. Epidemiological studies support the potential of improved glycemic control to reduce cardiovascular complications. An association between glycosylated hemoglobin (HbA(1c)) level and the risk for cardiovascular complications has frequently been reported. Most epidemiological data implicate postprandial hyperglycemia in the development of cardiovascular disease, whereas the link between fasting glycemia and diabetic complications is inconclusive. Moreover, in many studies, postprandial glycemia is a better predictor of cardiovascular risk than HbA(1c) level. Postprandial glucose may have a direct toxic effect on the vascular endothelium, mediated by oxidative stress that is independent of other cardiovascular risk factors such as hyperlipidemia. Postprandial hyperglycemia also may exert its effects through its substantial contribution to total glycemic exposure. The present review examines the hypothesis that controlling postprandial glucose level is an important strategy in the prevention of cardiovascular complications associated with diabetes.

Blood Glucose↗
PubMed2004

Health and economic impact of combining metformin with nateglinide to achieve glycemic control: Comparison of the lifetime costs of complications in the U.K.

BACKGROUND: To reduce the likelihood of complications in persons with type 2 diabetes, it is critical to control hyperglycaemia. Monotherapy with metformin or insulin secretagogues may fail to sustain control after an initial reduction in glycemic levels. Thus, combining metformin with other agents is frequently necessary. These analyses model the potential long-term economic and health impact of using combination therapy to improve glycemic control. METHODS: An existing model that simulates the long-term course of type 2 diabetes in relation to glycosylated haemoglobin (HbA1c) and post-prandial glucose (PPG) was used to compare the combination of nateglinide with metformin to monotherapy with metformin. Complication rates were estimated for major diabetes-related complications (macrovascular and microvascular) based on existing epidemiologic studies and clinical trial data. Utilities and costs were estimated using data collected in the United Kingdom Prospective Diabetes Study (UKPDS). Survival, life years gained (LYG), quality-adjusted life years (QALY), complication rates and associated costs were estimated. Costs were discounted at 6% and benefits at 1.5% per year. RESULTS: Combination therapy was predicted to reduce complication rates and associated costs compared with metformin. Survival increased by 0.39 (0.32 discounted) and QALY by 0.46 years (0.37 discounted) implying costs of pound 6,772 per discounted LYG and pound 5,609 per discounted QALY. Sensitivity analyses showed the results to be consistent over broad ranges. CONCLUSION: Although drug treatment costs are increased by combination therapy, this cost is expected to be partially offset by a reduction in the costs of treating long-term diabetes complications.

Journal Article↗
PubMed2004

Nasopharyngeal hamartoma: importance of routine complete nasal examination.

The authors report clinical experience in managing an 82-year-old female presenting with long-standing bilateral nasal obstruction resulting from a nasopharyngeal mass. The patient had undergone a number of treatments including surgery. The previous examinations, investigations and treatment had all been performed within the previous 10 years and although examination had been documented there was no evidence on review of the notes that the nasopharynx had been inspected either by nasendoscopy or indirectly. The mass was removed via a combined nasal and oral approach. Histopathological examination of the specimen was consistent with mesenchymal hamartoma. In addition to describing a rare presentation the authors believe this case highlights the importance of complete examination in all patients with nasal symptoms.

Aged↗
PubMed2003

Assessment and management of self-harm in older adults attending accident and emergency: a comparative cross-sectional study.

OBJECTIVE: Older people who undertake self-harm are at higher suicide risk than are younger patients. This study examines whether this greater risk is reflected in the assessment and after-care that older patients receive when they attend accident and emergency. METHOD: This cross-sectional study, set in the two accident and emergency departments in a large industrial city in Northern England, compared 141 consecutive attendances due to self-harm among older patients (aged 55 years and over) with a random sample of 125 attendances of younger people (aged 15-54) attending because of self-harm. Data were drawn from accident and emergency records and from psychiatric and general hospital casenotes. RESULTS: Compared with the younger group, older patients were significantly more likely to be admitted from accident and emergency to the general hospital, to receive a specialist assessment whilst at the hospital, and to be offered psychiatric after-care-either as a psychiatric in-patient or an out-patient. CONCLUSIONS: Fortunately, older people attending accident and emergency following self-harm seemed likely to receive psychosocial assessment from a mental health specialist, and they were much more likely than younger patients to be offered after-care. Hospitals will need to monitor accident and emergency and other records if they are to check that their services are responding to the high risks seen in older patients.

Adolescent↗
PubMed2003

Attendance at the accident and emergency department in the year before suicide: retrospective study.

BACKGROUND: The National Confidential Inquiry into suicides in England and Wales found that a quarter of suicides are preceded by mental health service contact in the year before death. However, visits to accident and emergency departments due to self-harm may not lead to a record of mental health service contact. Aims To determine the proportion of suicides preceded by accident and emergency attendance in the previous year. METHOD: We obtained the list of probable suicides in Leeds for a 38-month period, and examined the records from the city's accident and emergency departments for a year before each death. RESULTS: Eighty-five (39%) of the 219 people who later died by suicide had attended an accident and emergency department in the year before death, 15% because of non-fatal self-harm. Final visits due to self-harm were often shortly before suicide (median 38 days), but the National Confidential Inquiry recorded about a fifth of them as 'not in contact' with local mental health services. CONCLUSIONS: Although many suicides are preceded by recent attendance at accident and emergency departments due to non-fatal self-harm, local mental health service records may show no recent contact. Suicide prevention might be enhanced were accident and emergency departments and mental health services to work together more closely.

Adolescent↗
PubMed2003

Self-injury attendances in the accident and emergency department: Clinical database study.

BACKGROUND: Self-injury is a neglected area of self-harm research and we know little about its epidemiology, hospital care and outcome. Aims To provide epidemiological data on self-injury and compare hospital management of self-injury with that for self-poisoning. METHOD: Data were collected on all self-harm attendances to the general hospitals in Leeds over an 18-month period. RESULTS: People attending hospital for self-injury or self-poisoning do not form mutually exclusive groups. There were higher proportions of self-injury episodes compared with self-poisoning, where a history of self-harm or contact with mental health services had been recorded. Fewer psychosocial assessments were carried out after episodes of self-injury compared with self-poisoning but, when they were, follow-up was recommended more often. CONCLUSIONS: The clinical importance of self-injury is not mirrored by the level of psychosocial assessment and after-care provided.

Adolescent↗
PubMed2002

The effect of parental expressed emotion on glycaemic control in children with Type 1 diabetes. Parental expressed emotion and glycaemic control in children.

OBJECTIVE: To measure expressed emotion (EE) in parents of young children with diabetes and to examine the relation between EE and glycaemic control in children with Type 1 diabetes in a longitudinal study over 24 months. We hypothesised that good glycaemic control, as measured by low glycated haemoglobin levels, would be predicted by high parental emotional over-involvement, low frequency of critical comments and absence of hostility. We predicted that these effects would be stronger in maternal than paternal scores. METHODS: Forty-seven children attending a Paediatric Diabetes Clinic and their parents were studied over 24 months. Glycated haemoglobin was measured on three occasions, at the start of the study period, 12 and 24 months later. At 12 months, parental EE was measured using an adapted version of the Camberwell Family Interview, and child emotional and behavioural problems were measured using the parent version of the Child Behavior Checklist. Multiple regression models were used to test the hypotheses. RESULTS: Forty-three maternal and 33 paternal interviews of adequate quality for analysis were obtained. Paternal hostility was found to be associated with elevated glycated haemoglobin measured 12 months before interview and 12 months after interview, accounting for 22% and 29% of the variation in glycated haemoglobin respectively. CONCLUSIONS: We did not find that parental emotional over-involvement or criticism predicted glycaemic control. Presence of hostility was important, but in contrast to our hypothesis, this was paternal rather than maternal hostility. We suggest that (i) relatively absent, rejecting fathers play little role in diabetes management and children perceive this negatively, or (ii) mothers who are unsupported by fathers cannot in turn support their children in diabetes care.

Adolescent↗
PubMed2002

Problems reported by self-harm patients: perception, hopelessness, and suicidal intent.

OBJECTIVE: Research suggests that problem-solving therapy may be an effective intervention following self-harm. This study determines the relation between self-harm patients' perceptions of their problems and their expressions of hopelessness and suicidal intent. METHOD: One hundred fifty patients admitted to a district hospital following self-harm were asked questions about the type and perceived solubility of their problems. In addition, in each case, the patient completed a Beck's hopelessness scale and a psychiatrist completed a Beck's suicidal intent scale. RESULTS: 66% of patients, and more of the males than of the females, recorded at least one problem that they believed to be insoluble; such problems were most often in the area of relationships. Patients who reported insoluble problems experienced higher levels of hopelessness and more suicidal intent. There was significant correlation among the number of insoluble problems, hopelessness, and suicidal intent. CONCLUSIONS: People who undertake self-harm report insoluble relationship problems. When assessing hopelessness and suicidal intent in self-harm patients, clinicians should ask about perception of insoluble problems.

Adolescent↗
PubMed2002

Fatal and non-fatal repetition of self-harm. Systematic review.

BACKGROUND: Non-fatal self-harm frequently leads to non-fatal repetition and sometimes to suicide. We need to quantify these two outcomes of self-harm to help us to develop and test effective interventions. AIMS: To estimate rates of fatal and non-fatal repetition of self-harm. METHOD: A systematic review of published follow-up data, from observational and experimental studies. Four electronic databases were searched and 90 studies met the inclusion criteria. RESULTS: Eighty per cent of studies found were undertaken in Europe, over one-third in the UK. Median proportions for repetition 1 year later were: 16% non-fatal and 2% fatal; after more than 9 years, around 7% of patients had died by suicide. The UK studies found particularly low rates of subsequent suicide. CONCLUSIONS: After 1 year, non-fatal repetition rates are around 15%. The strong connection between self-harm and later suicide lies somewhere between 0.5% and 2% after 1 year and above 5% after 9 years. Suicide risk among self-harm patients is hundreds of times higher than in the general population.

Humans↗