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Biomedical subjects

G Wilkinson

Publications and source records attributed to G Wilkinson.

At least 19 recordsLinked to original sources
PubMed1992

Assessment of psychological care in general practice.

OBJECTIVE: To pilot a method of assessing psychological care by general practitioners. DESIGN: Prospective examination of psychological care given in general practice by using general health questionnaire with predetermined quantifiable and case specific indices of outcome established at the original consultation. SETTING: Rural general practice in Clwyd, North Wales. SUBJECTS: 447 consecutive adult general practice attenders. MAIN OUTCOME MEASURES: Three month follow up consultation rates, one year retrospective consultation rates, continuity of care, changes in general health questionnaire scores at follow up, general satisfaction, and acceptability of outcome measures. RESULTS: The principal and trainee identified 72 patients with psychological problems, 46 of whom had new conditions. 133 patients scored over 6 on the 28 item general health questionnaire, 33 of whom were identified as new cases by the general practitioners. 62 patients were seen at follow up, including 23 patients identified by the questionnaire but not by the doctor. The doctors used diagnostic terms to describe the presenting condition in 38 cases. At three month follow up the general health questionnaire scores had fallen by more than 5 points in 22/39 patients identified and managed by doctors and 11/23 identified by the questionnaire. The agreed index of good outcome was almost or completely achieved by 20 of the 39 patients managed by doctors. CONCLUSION: Quantifiable methods of evaluating the quality of the structure, process, and outcome of psychological care can be achieved in general practice.

Community Mental Health Services↗
PubMed1992

Nursing comes of age.

Explore the source record for details and available documents.

Attitude of Health Personnel↗
PubMed1992

Alcohol consumption and lung cancer in white males.

Experimental and epidemiologic investigations in alcoholic and nonalcoholic populations have suggested a role of alcohol in lung carcinogenesis. The association between alcohol consumption and lung cancer was investigated among 280 White males with histologically confirmed, primary lung cancer and 564 White male controls, participants in the Western New York Diet Study (United States). Among heavy smokers (over 40 pack-years), total alcohol consumption was associated with an increased risk of lung cancer with adjustment for age, years of education, pack-years of cigarette smoking, and intake of carotenoids and fat. In this group, the odds ratio for drinkers of more than 24 drinks per month was 1.6 compared with those who drank less. Drinkers of more than 12 beers per month were 1.6 times more likely to develop lung cancer than nondrinkers of beer after controlling for age, years of education, and cigarette smoking (95 percent confidence interval = 1.0-2.4, P for trend = 0.003). Occupational and dietary factors did not seem to explain these findings. Although cigarette smoking is the major cause of lung cancer, the role of alcohol, independent or in interaction with cigarette smoking, deserves further investigation.

Adult↗
PubMed1992

Why people with probable minor psychiatric morbidity consult a doctor.

This epidemiological investigation examines factors determining medical consultation in people with probable minor psychiatric morbidity. About 54% of people with probable minor psychiatric morbidity and about 23% of the (numerically much greater) remainder with lower probability of psychiatric morbidity consulted a doctor, usually a primary care physician, in the two weeks prior to a research interview. Medical consultation rates were higher in females than in males. The dominant finding was that in people with probable minor psychiatric morbidity physical illness was strongly associated with medical consultation. Almost 89% of males and 97% of females with probable minor psychiatric morbidity and physical illness consulted a doctor in the two weeks prior to interview. Logistic regression modelling was used to investigate the joint effects on medical consultation of physical illness and six socio-demographic variables, and physical illness emerged as the major single determinant of medical consultation in women and, in men, it exerted its effect through an interaction with lower educational level.

Adolescent↗
PubMed1992

A longitudinal study of general practitioner consultations for psychiatric disorders in adolescence.

Patterns of psychiatric diagnoses given during adolescence to a group of individuals continuously registered with a single general practitioner in South London over 20 years were analysed first during 'early adolescence' and secondly during 'early adulthood'. Psychiatric diagnoses were found to be relatively common. Of the young adolescents who received a psychiatric diagnosis (almost one in ten of the group), 38% received a psychiatric diagnosis as young adults compared with only 16% of the remainder. Comorbidity was found to be very common--over 50% of young adults with a diagnosis of depression also had a diagnosis of anxiety and phobic neuroses. Young people with problems of a psychological nature therefore deserve more attention, particularly from the primary care team.

Adolescent↗
PubMed1992

QALYs in mental health: a case study.

The applicability of the Charing Cross health indicator (CH-X) to the field of mental health was investigated in a community setting using descriptive statistics and principal components analysis. The CH-X is based on assessments of (i) distress and (ii) disability. Our results suggest that with respect to quality of life in mental health settings measurements of distress may be of greater importance than disability. In addition, the CH-X may be insensitive to variations in the severity of mental disorder and may primarily reflect physical disability as opposed to social disability. QALYs methodology may require the adoption of a multidimensional measure of health in order to fulfil its proposed role in comparing medical and mental health programmes.

Persons with Disabilities↗
PubMed1992

Diet, smoking, and alcohol in cancer of the larynx: a case-control study.

A case-control study among white men in western New York was conducted from 1975 through 1985 to examine diet and other risk factors for laryngeal cancer. Incident pathologically confirmed cases (250) and age- and neighborhood-matched controls (250) were interviewed to determine usual diet and lifetime use of tobacco and alcohol. Cigarettes were strongly associated with risk; pipes and cigars were not. Beer and hard liquor but not wine were associated with increased risk. Dietary fat and carotenoids were related to risk in opposite ways. The upper quartile odds ratio for dietary fat was 2.40 [95% confidence interval 1.26, 4.55], and the upper quartile odds ratio for carotenoids was 0.51 (0.26, 1.01). There was effect modification by smoking. Carotenoids were most negatively associated with risk among the lightest smokers, whereas dietary fat was most positively associated with risk among the heaviest smokers. Total calories, protein, and retinol were associated with increased risk; there was no relationship between laryngeal cancer and vitamin C, vitamin E, carbohydrate, or dietary fiber. This study again demonstrates the strong association between tobacco and alcohol and laryngeal cancer and also suggests that diets low in carotenoids and high in fat may increase risk.

Aged↗
PubMed1992

Medical students' attitudes to psychiatry in Chile.

There is controversy about the influence of psychiatric clerkships on medical students' attitudes to psychiatry. In general, studies in developed countries have found a short-lasting improvement in attitudes to psychiatry after a psychiatric clerkship. The present study was designed to measure changes in medical students' attitudes following a psychiatric clerkship in a developing country. Medical students from the Faculty of Medicine, University of Chile were interviewed before and after a psychiatric clerkship using a translation into Spanish of an attitude-to-psychiatry questionnaire used previously in the UK. The results were similar to those reported from developed countries. There was a marked early improvement in students' attitudes following their psychiatric clerkship which gradually faded over 3 years. There is scope for improvement in psychiatric undergraduate medical teaching in Chile and this might help to make more lasting improvements in attitudes to psychiatry among medical students.

Attitude of Health Personnel↗
PubMed1992

Construction and properties of a mutant of herpes simplex virus type 1 with glycoprotein H coding sequences deleted.

A mutant of herpes simplex virus type 1 (HSV-1) in which glycoprotein H (gH) coding sequences were deleted and replaced by the Escherichia coli lacZ gene under the control of the human cytomegalovirus IE-1 gene promoter was constructed. The mutant was propagated in Vero cells which contained multiple copies of the HSV-1 gH gene under the control of the HSV-1 gD promoter and which therefore provide gH in trans following HSV-1 infection. Phenotypically gH-negative virions were obtained by a single growth cycle in Vero cells. These virions were noninfectious, as judged by plaque assay and by expression of beta-galactosidase following high-multiplicity infection, but partial recovery of infectivity was achieved by using the fusogenic agent polyethylene glycol. Adsorption of gH-negative virions to cells blocked the adsorption of superinfecting wild-type virus, a result in contrast to that obtained with gD-negative virions (D. C. Johnson and M. W. Ligas, J. Virol. 62:4605-4612, 1988). The simplest conclusion is that gH is required for membrane fusion but not for receptor binding, a conclusion consistent with the conservation of gH in all herpesviruses.

Animals↗
PubMed1991

General practitioner referral to specialist psychiatric services: a comparison of practices in north- and south-Verona.

Specialist psychiatric services run by the Italian National Health Service are mainly hospital-based in North-Verona and community-based in South-Verona. Ninety-two GPs from both areas participated in a one-day survey of their provision of psychiatric care, and this paper focuses on socio-demographic and clinical variables associated with specialist psychiatric referral. The one-day prevalence figure for GP referral to specialist psychiatric services was 7.3% (17.6/10,000): the figures did not differ between the sexes or between the two areas. Whereas in North-Verona 49% of the patients referred were sent to the two local hospital-based public services and 51% to other agencies (mainly to private psychiatrists), in South-Verona 71% of referrals were to the community-based public service. Log-linear analysis showed that past psychiatric history, psychological presenting complaint, social problems and GPs' psychiatric diagnosis exerted positive joint main effects on GP referral to specialist psychiatric services, and that diagnosed organic illness had a negative effect in this regard. In the presence of a psychological complaint, a psychiatric diagnosis proved to be quite unimportant, so that those without a psychiatric diagnosis were just as likely to be referred as those with one. However, in the absence of a psychological complaint a GP diagnosis of depression greatly increased the risk of referral. Though the type of psychiatric service proved not to be an important determinant of GP referral to specialist psychiatric services it influenced the GPs' choice of referral agency.

Adolescent↗
PubMed1991

Life events, social problems and physical health status as predictors of emotional distress in men and women in a community setting.

The main aim of this study was to construct logistic models of emotional distress (defined as a GHQ-30 score of 6 or greater) in a community sample of 226 men and 225 women. The independent variables included were: sociodemographic characteristics, physical health status, social problems and undesirable life events. Univariate comparisons showed that in both sexes undesirable life events and social problems were associated with emotional distress; in men the presence of physical symptoms and widowed, separated or divorced status also showed such an association. Separate logistic regression models for men and women confirmed the importance of undesirable life events and social problems as predictors for emotional distress. In women there was also a significant interaction effect between the two variables on emotional distress. Sociodemographic characteristics and physical health status did not exert a statistically significant effect in these models.

Adaptation, Psychological↗
PubMed1991

Meta-analysis of double-blind placebo-controlled trials of antidepressants and benzodiazepines for patients with panic disorders.

Meta-analysis of 19 double-blind placebo-controlled trials of antidepressants (N = 13) and benzodiazepines (N = 6) for patients with panic disorders showed that active treatment had 25% greater success rate than placebo over a mean duration of 14 weeks. There were no statistically significant differences observed between treatment sub-groups (antidepressants--mean duration 16 weeks; and benzodiazepines--mean duration 7 weeks). On this basis antidepressants and benzodiazepines prescribed in clinical settings are likely to be equally effective in the short-term treatment of people with panic disorders.

Anti-Anxiety Agents↗
PubMed1991

Folate intake and carcinogenesis of the colon and rectum.

Experimental evidence suggests that folate depletion plays a role in carcinogenesis. A case-control study examining folate intake was conducted. Some 428 colon and 372 rectal cancer cases with matched neighbourhood controls were interviewed regarding usual intake of foods, including food preparation. Unadjusted folate was not associated with risk of either cancer. Controlling for kilocalories, odds ratios (ORs) for those with the highest folate intake were 0.5 (95% confidence interval (CI): 0.24-1.03) and 0.31 (95% CI: 0.16-0.59) for females and males for rectal cancer. There was no change in colon cancer risk associated with folate intake. There was an indication of an interaction of folate and alcohol intake; the difference in risk associated with low and high folate intake was highest for males in the highest alcohol category. Associations were of similar magnitude for other dietary factors correlated with folate. It appears that intake of folate or a correlated factor may be negatively related to risk of rectal cancer.

Alcohol Drinking↗
PubMed1991

The 1978 Italian mental health law--a personal evaluation: a review.

"The author discusses the sociopsychiatric consequences of the 1978 Italian mental health law. He also reviews the international scientific ideas that led up to it. The sociopolitical psychiatric views of the late Franco Basaglia, pioneer of the change in the mental health system of the Italian Republic, are described. Statistical reports and critical analyses are reported. Objective data, based on the author's personal experience as a practising psychiatrist in Rome, Italy, from 1969 to 1987, are given."

Activities of Daily Living↗
PubMed1990

Risks associated with source of fiber and fiber components in cancer of the colon and rectum.

In this case-control study, we examined the food sources of fiber and fiber solubility to determine whether particular components of dietary fiber were differentially associated with risk of colon and rectal cancer. In Western New York, cases with pathologically confirmed, single, primary cancers of the colon and rectum as well as age-, sex- and neighborhood-matched controls were interviewed from 1975-1986. The sample included 428 colon case-control pairs (223 females, 205 males) and 422 rectal case-control pairs (145 females, 277 males). Subjects were interviewed regarding usual quantity and frequency of consumption of foods. For the colon, risk decreased with intake of grain fiber for both females and males and with intake of fruit/vegetable fiber for males only. Insoluble grain fiber was more strongly associated with risk than soluble grain fiber. For the rectum, fruit/vegetable fiber was associated with decreased risk, whereas grain fiber was not. There was no difference in risk for soluble and insoluble fiber components for the rectum. Analysis of risk associated with fiber by food source and by components of the fiber may provide insight into possible mechanisms of a fiber effect on cancer of the colon and rectum.

Colonic Neoplasms↗
PubMed1990

Mental health and medical consultation in primary care settings.

This paper examines the effect of psychiatric morbidity, as measured by the GHQ-60, on the probability of being in contact with a primary care physician, and the socio-demographic factors which influenced this effect. We found that the presence of psychiatric morbidity emerged as a major determinant of primary care utilization in both sexes, and about one-sixth of consultations in men and one-fifth of consultations in women could be attributed to it. Logistic modelling was used to investigate the joint effect on general practitioner consultation of psychiatric morbidity and seven socio-demographic variables. Sex, age, and psychiatric morbidity exerted independent, but not interactive, effects on consultation.

Adolescent↗