Biomedical subjects

J Keene

Publications and source records attributed to J Keene.

At least 19 recordsLinked to original sources

PubMed2006

Are mental health problems associated with use of Accident and Emergency and health-related harm?

BACKGROUND: Previous findings indicate that mental health problems are common in Emergency departments; however, there are few studies of the extent of health-related problems and emergency service use in mental health populations as a whole. METHODS: Record linkage methods were used to map the association between mental health, age, gender, and health-related harm across total health and mental health care populations in one geographical area, over three years. By examining patterns of health-related harm, an accurate profile of mentally ill Emergency patients was generated enabling identification of factors that increased vulnerability to harm. RESULTS: Of the total population of 625 964 individuals, 10.7% contacted Accident and Emergency (A&E) over three years, this proportion rose to 28.6% among the total secondary care mental health population. Young men and older women were more likely to contact A&E, both overall and within mental health populations and were also more likely to be frequent attendees at A&E. Four distinct groups (typologies) of mental health patients attending A&E emerged: young, male frequent attendees with self-inflicted and other traumatic injuries; young females also presenting with self-harm; older patients with multiple medical conditions; and very old patients with cardiac conditions and fractures. CONCLUSION: The study indicates increased A+E service use and unmet health-related need within a total mental health population. It identifies specific 'care populations' particularly vulnerable to accidents and self-harm and highlights the need for targeted services for mentally ill groups who may not access traditional health and social care services effectively.

Adolescent↗

PubMed2005

Age and gender differences in health service utilization.

BACKGROUND: This study of age and gender profiles of health care populations fills a gap in the research literature by providing a population study of both single health agency and inter-agency 'Shared Care' populations. METHODS: It combines anonymous data to link individual cases across Community Health (N = 82 751), Mental Health (N = 19 029) and Social Services (N = 19 461) populations in one county Health Authority (N = 646 239) over 3 years. It compares age and gender characteristics of single care populations and overlapping inter-agency 'Shared Care'populations. RESULTS: Approximately two-thirds of all care populations were female compared to half (513.1) in the general Health Authority population. These differences were accentuated for almost all inter-agency 'Shared Care' populations, where, whilst a younger care profile emerged for mental health and social services dual agency clients, for other shared populations a distinct care profile emerged of greater proportions of older, female and older female patients. Gender differences were also apparent for different care groups within a total Community Health care population. Whilst females made much more use of services overall, in Community Health, older males were more likely to receive rehabilitative support services. CONCLUSION: Age and gender profiles of health care agency and inter-agency populations clarify service use patterns and identify high proportions of women in health and social care populations, particularly in older care populations. This type of care population analysis could inform single agency and inter-agency shared care planning and commissioning.

Adolescent↗

PubMed2005

Gender differences in older patient populations: a case linkage study of community health, mental health, and social services in the United Kingdom.

We identify gender differences in older health and social care populations by comparing the total population of older people with the total population of women and the total population of older women, respectively. We combine anonymised data across community health (CH; N = 82,751), mental health (MH; N = 19,029), and social care service (SC; N = 19,461) populations in one UK county (N = 496,863) over 3 years. Approximately two thirds of older care populations were female. In both single- and dual-agency care populations a profile emerged of older patients, female patients and older female patients, this profile varied across different diagnostic and care groups.

Age Distribution↗

PubMed2005

A cross sectional study of assessed need and multiple service use among a self harm population: informing the development of inter-agency integrated care.

PURPOSE: To examine assessed need and wider health and social care service contact for a total Deliberate Self Harm (DSH) population in the UK. METHODS: The study first recorded assessed needs and referrals for this population, then used a new method of identifying and describing all other agency contacts for this population by combining the total anonymised DSH population data with total mental health, health and social care agency populations for one geographical area. RESULTS: For a DSH unit population of 427, half (53%) were assessed with mental health and 18% with drug or alcohol problems; two thirds were referred to appropriate services. Wider service contact for a total DSH population (n=2,205 over three years) confirmed that 53% had contacted mental health (compared to 2.9% of the geographical area population (n=646,239) and 7.4% of the total hospital Emergency population (n=91,911). The DSH population was three times more likely to contact social care agencies (21.1%: 7.2%) and ten times more likely to attend drug (7.3%: 0.7%) and alcohol agencies (8.8%: 0.8%) CONCLUSIONS: This new method described the wider service use of one vulnerable shared care population, it is suggested that the method could be used to inform the development of integrated care initiatives in different areas.

Journal Article↗

PubMed2004

Loss of serotonin 5-HT2A receptors in the postmortem temporal cortex correlates with rate of cognitive decline in Alzheimer's disease.

RATIONALE: Previous studies have demonstrated reductions of serotonin 5-HT 2A receptors in the neocortex of Alzheimer's disease (AD) patients. However, it is unclear whether such losses play a role in the cognitive decline of AD. OBJECTIVES: To correlate neocortical 5-HT 2A receptor alterations with cognitive decline in AD. METHODS: Postmortem frontal and temporal cortical 5-HT 2A receptors were measured by [3H]ketanserin binding in aged controls as well as in a cohort of AD patients who had been longitudinally assessed for cognitive decline and behavioral symptoms. RESULTS: 5-HT 2A receptor densities in both regions were reduced in severely demented AD patients compared to age-matched controls. In the temporal cortex, this reduction also correlated with the rate of decline of Mini-Mental State Examination (MMSE) scores. The association between 5-HT 2A receptor loss and cognitive decline was independent of the effects of choline acetyltransferase (ChAT) activity and presence of behavioral symptoms. CONCLUSIONS: Our data suggest that loss of neocortical 5-HT 2A receptors may predict for faster cognitive decline in AD, and point to serotomimetics as potentially useful adjuvants to cholinergic replacement therapies.

Aged↗

PubMed2003

Mental health patients in criminal justice populations: needs, treatment and criminal behaviour.

BACKGROUND: Government policy requires that health and social care agencies work more closely together and in partnership with the criminal justice system. There is a well-established relationship between crime and mental disorder. METHOD: The Tracking Project provides for the first time in England the means of collating and analysing data on mental disorder (defined as receiving secondary care as patients of a Mental Health Trust) and crime (defined as all those charged with an offence). Data were collected over a three-year period for all individuals who had contact with the criminal justice system and mental health services in an English county. RESULTS: In a county population of 800,400, some 30,329 were offenders. More than a third had used a health or social care service during the three-year period; 8.0% were mentally disordered. Those offenders aged 25-64 and who contacted the police more than once were significantly more likely to be mentally disordered. Type of offence was also a relevant variable. The probation service showed broadly similar results. DISCUSSION: The research has provided for the first time substantive quantitative evidence of the relationship between crime and mental disorder. The results can be used as the basis for further work to target assessment and risk reduction measures at those most at risk.

Adolescent↗

PubMed2002

Estimating the relationship between disease progression and cost of care in dementia.

BACKGROUND: Previous studies have shown a positive relationship between disease severity and cost. AIMS: To explore the factors affecting time to institutionalisation and estimate the relationship between the costs of care and disease progression. METHOD: Retrospective analysis of a longitudinal data-set for a cohort of 100 patients diagnosed with Alzheimer's disease or vascular dementia. RESULTS: Changes in both Mini-Mental State Examination (MMSE) and Barthel scores have independent and significant marginal effects on costs. Each one-point decline in the MMSE score is associated with a pound sterling 56 increase in the four-monthly costs, whereas each one-point fall in the Barthel index is associated with a pound sterling 586 increase in costs. CONCLUSIONS: It may be inappropriate for economic models of disease progression in dementia to be based solely on measures of cognitive change. MMSE and the Barthel index are independent significant predictors of time to institutionalisation and cost of care, but changes in the Barthel index are particularly important in predicting costs outside institutional care.

Age Factors↗

PubMed2001

Psychosis of Alzheimer's disease is associated with elevated muscarinic M2 binding in the cortex.

OBJECTIVES: Results from recent drug trials suggest a role for the cholinergic system in the manifestation of neuropsychiatric symptoms in AD. To date, the status of muscarinic acetylcholine receptor subtypes in AD in relation to accompanying behavioral disturbances is unknown. This study aimed to measure alterations of muscarinic M(1) and M(2) receptor binding in the frontal and temporal cortex of AD and to correlate the neurochemical findings with clinical features. METHODS: The cognitive and behavioral features of 26 patients with AD were assessed prospectively using standardized tests. Together with 14 matched controls, the status of muscarinic M(1) and M(2) receptors in the postmortem frontal and temporal cortex of these patients were measured by radioligand binding assays and were correlated with clinical data. RESULTS: Compared with controls, M(2) receptor density was reduced only in the frontal cortex of AD, whereas M(1) was unaffected. Within the AD group, the neurochemical variables were not affected by demographic factors, disease severity, or cognition. Instead, M(2) receptor density was increased in the frontal and temporal cortex of patients with AD with psychotic symptoms compared with those without these symptoms. CONCLUSIONS: This study suggests a role for M(2) receptors in the psychosis of AD and may provide the rationale for treatment of behaviorally perturbed patients with AD with cholinomimetics and M(2) antagonists.

Aged↗

PubMed2001

Death and dementia.

OBJECTIVE: To investigate the last phase of dementia and the causes of death; comparing autopsy and death certificate diagnoses. DESIGN: Prospective, 11-year, longitudinal study of behavioural and psychological changes in dementia, with autopsy follow-up. SETTING: Participants with dementia, living at home with a carer. All lived in Oxfordshire, UK. PARTICIPANTS: Ninety-one people with dementia (Alzheimer's disease and/or vascular dementia) who died during the course of the study. MEASURES: At four-monthly intervals, carers were interviewed about the participants' behaviour using the Present Behavioural Examination. Participants were also assessed cognitively. Causes of death were established from death certificates and, where possible, from post-mortem examination. RESULTS: The main immediate cause of death recorded at autopsy was pneumonia (57%), followed by cardiovascular disease (16%) and pulmonary embolus (14%). This agreed with the immediate cause of death on 53% of death certificates. Pulmonary embolism and bronchopneumonia were under-reported on death certificates. Dementia was mentioned on 73% of death certificates. The dementing illness lasted for a mean of 8.5 years with 58% dying in a debilitated state associated with severe dementia. In the period before death, 35% were unable to walk, 58% were hypophagic, 73% were incontinent of urine, 21% incontinent of faeces and 76% entered an institution permanently for a mean period of 18 months. CONCLUSION: Family and professional carers of people with dementia can be given some information about prognosis to help them plan for the likely outcome of dementia.

Aged↗

PubMed2001

Wandering in dementia: a longitudinal study.

OBJECTIVE: This article analyzes the natural history of wandering behavior throughout the course of dementia. DESIGN: Prospective, 10-year, longitudinal study of wandering behavior in dementia, with autopsy follow-up. SETTING: Participants with dementia, living at home with a carer. All lived in Oxfordshire, UK. PARTICIPANTS: Eighty-six people with dementia who were living at home with a carer and who were able to walk unaided at entry to study. MEASURES: At 4-monthly intervals, the carers were interviewed using the Present Behavioural Examination to assess wandering behavior in detail; participants with dementia were assessed cognitively. Nine types of "wandering" behavior were distinguished. RESULTS: Changes in wandering behavior were not generally related to gender, age, or time since onset of dementia. Onset of different types of wandering behavior showed some relationship with cognitive state. Various forms of increased walking first appeared during moderate dementia, each type typically persisting for 1 to 2 years. Late dementia was characterized by decreased walking and immobility. CONCLUSIONS: Wandering behavior in dementia can cause great problems for carers. There are different causes for such changes, some of which are related to cognitive ability, for example increased confusion results in ineffectual "pottering" and getting lost. Increased walking at night corresponds with disruption of diurnal rhythm.

Activity Cycles↗

PubMed2001

Shared patients: multiple health and social care contact.

The paper describes results from the 'Tracking Project', a new method for examining agency overlap, repeat service use and shared clients/patients amongst social and health care agencies in the community. This is the first project in this country to combine total population databases from a range of social, health care and criminal justice agencies to give a multidisciplinary database for one county (n = 97,162 cases), through standardised anonymisation of agency databases, using SOUNDEX, a software programme. A range of 20 community social and health care agencies were shown to have a large overlap with each other in a two-year period, indicating high proportions of shared patients/clients. Accident and Emergency is used as an example of major overlap: 16.2% (n = 39,992) of persons who attended a community agency had attended Accident and Emergency as compared to 8.2% (n = 775,000) of the total population of the county. Of these, 96% who had attended seven or more different community agencies had also attended Accident and Emergency. Further statistical analysis of Accident and Emergency attendance as a characteristic of community agency populations (n = 39,992) revealed that increasing frequency of attendance at Accident and Emergency was very strongly associated with increasing use of other services. That is, the patients that repeatedly attend Accident and Emergency are much more likely to attend more other agencies, indicating the possibility that they share more problematic or difficult patients. Research questions arising from these data are discussed and future research methods suggested in order to derive predictors from the database and develop screening instruments to identify multiple agency attenders for targeting or multidisciplinary working. It is suggested that Accident and Emergency attendance might serve as an important predictor of multiple agency attendance.

Accidents↗

PubMed2001

Synaptic pathology in prefrontal cortex is present only with severe dementia in Alzheimer disease.

Synaptic pathology is proposed to be integral to the clinical expression of Alzheimer disease (AD). Most studies have assessed only the vesicle protein synaptophysin as a measure of synaptic integrity. The interrelationships of synaptophysin, other presynaptic proteins, the cholinergic system, and severity of dementia in AD remain unclear. We studied the presynaptic proteins synaptophysin, syntaxin and SNAP-25, along with choline acetyltransferase (ChAT) activity in prefrontal cortex (BA 46) samples from 18 subjects with AD and 16 controls. Mean values of presynaptic protein immunoreactivities were significantly reduced, by 21%-28%, and ChAT activity was reduced by 41% in the AD groups. Synaptic protein immunoreactivity and ChAT activity were correlated with Mini-Mental State Examination scores obtained 1 yr prior to death. When AD cases were subgrouped into mild/moderate and severe illness at time of death, all differences in presynaptic proteins and ChAT activity were significant between controls and severe cases. However, no significant differences were detected in BA 46 between controls and mild/moderate cases. Considerable synaptic reserve or plasticity remains in BA 46 until the late stages of AD. Synaptophysin and ChAT appear to be more vulnerable in severe AD than are syntaxin or SNAP-25.

Aged↗

PubMed2000

Cholinergic deficits contribute to behavioral disturbance in patients with dementia.

BACKGROUND: Noncognitive behavioral changes such as depression, aggressive behavior, psychosis, and overactivity occur frequently in patients with dementia, in addition to cognitive impairment, and often determine the need for institutionalization. The biochemical basis of such changes is poorly understood. Clinical trial data indicate that cholinomimetics improve noncognitive behaviors. This study investigated the relationship between markers of the cholinergic and dopaminergic neurotransmitter systems and noncognitive behavioral symptoms assessed during the course of dementing illness. METHOD: Brains from 46 patients with dementia (36 with AD and 10 with mixed or other dementias using Consortium to Establish a Registry for AD criteria) were examined together with 32 normal controls. The patients with dementia had been evaluated every 4 months, often over several years, for cognitive performance (Mini-Mental State Examination) and behavior (Present Behavioral Examination). Concentrations of dopamine (DA) and major metabolites, choline acetyltransferase activity (ChAT), and density (Bmax) of DA D1 receptors in frontal and temporal cortex were studied by radioligand binding protocols. None of the patients was receiving cholinomimetic drugs. RESULTS: ChAT activity, but no other neurochemical markers, was reduced in AD compared with controls. Loss of ChAT activity correlated with cognitive impairment. Lowered ChAT activity also correlated with increasing overactivity in patients with dementia in both frontal and temporal cortex whereas ChAT:DA and ChAT:D1 ratios in temporal cortex correlated negatively with aggressive behavior. CONCLUSIONS: Disturbance of the cholinergic system may underlie both cognitive and some noncognitive behavioral changes in dementia, providing a basis for rational therapy.-1467

Aged↗

PubMed2000

The limits of therapeutic models of substance misuse for policy and practice. A qualitative study of two agencies.

This paper presents the analysis from a qualitative study of two substance misuse treatment agencies, one based on the Twelve Step AA model and one on a Cognitive Behavioural approach. Analysis of ethnographic data and 38 semi-structured interviews with staff indicated that the agencies were in practice using very similar methods. However, the use of particular therapist models gave rise to different definitions of problems, assessment and notions of success. The paper considers the implications of these findings for policy and practice. It distinguishes between the therapeutic usefulness of theory and its role in focusing assessment procedures, limiting interventions, defining success and determining the timing of treatment termination. It considers how far models might influence purchasing and service development through research and evaluation.

Journal Article↗

PubMed2000

L1551NE-Discovery of a Binary Companion.

L1551NE is a very young (class 0 or I) low-mass protostar located close to the well-studied L1551 IRS 5. Here we present evidence, from 1.3 mm continuum interferometric observations at approximately 1&arcsec; resolution, for a binary companion to L1551NE. The companion, whose 1.3 mm flux density is approximately 13 that of the primary component, is located 1&farcs;43 ( approximately 230 AU at 160 pc) to the southeast. The millimeter-wave emission from the primary component may have been just barely resolved, with a deconvolved size of approximately 0&farcm;82x0&farcm;70 ( approximately 131x112 AU). The companion emission was unresolved (<100 AU). The pair is embedded within a flattened circumbinary envelope of size approximately 5&farcm;4x2&farcm;3 ( approximately 860x370 AU). The masses of the three components (i.e., from the circumstellar material of the primary star and its companion and the envelope) are approximately 0.044, 0.014, and 0.023 M middle dot in circle, respectively.

Journal Article↗

PubMed2000

Progressive decline in NART score with increasing dementia severity.

Although the National Adult Reading Test (NART) is widely used to estimate premorbid intellectual ability in adults with possible or probable dementia, it may be less resilient to the progress of Alzheimer's Disease (AD) than was initially assumed. This paper reports performance at four annual assessments of 78 people with either autopsy confirmed (n = 50) or clinical diagnosis of AD (n = 28). Results indicate that NART score does decline over time and that extent of decline is a function of MMSE score on entry to the study but is not dependent on age, education or time post onset of dementia.

Aged↗

PubMed1999

Natural history of aggressive behaviour in dementia.

OBJECTIVE: This article analyses changes in aggressive behaviour throughout the course of dementia. DESIGN: Prospective, 10 year, longitudinal study of aggressive behaviour in dementia, with autopsy follow-up. SETTING: Subjects with dementia, living at home with a carer, Oxfordshire, UK. PARTICIPANTS: Ninety-nine people with dementia (Alzheimer's disease and/or vascular dementia) who were living at home with a carer. MEASURES: At 4-monthly intervals, the carers were interviewed about the subjects and the subjects were assessed cognitively. Subjects' behaviour was assessed using the Present Behavioural Examination. This is an investigator-based, semi-structured interview consisting of eight main sections monitoring behavioural and psychological change. Eight different aspects of aggressive behaviour were assessed in detail and comparison made with other relevant factors. RESULTS: Verbal aggression is the most common and longest lasting form of aggressive behaviour. Aggressive resistance and physical aggression are most likely to persist until death. Intimate care is the main factor precipitating aggressive behaviour. There are no correlations between any type of aggressive behaviour and age, gender or time since onset of dementia. CONCLUSIONS: Aggressive behaviour creates problems for carers. In general, the physical types of aggressive behaviour are most prevalent in people with more severe dementia.

Aged↗

PubMed1999

A survey of women's experiences of vaginal loss from 24 hours to three months after childbirth (the BLiPP study).

OBJECTIVE: To describe the range of normal vaginal loss as reported by women from 24 hours after delivery until three months postnatally. SETTING: Two health districts in the south of England. METHODS: A prospective survey of women's experiences and expectations of the duration, amount and colour of vaginal loss after childbirth. The term vaginal loss includes all types of fluid loss from the vagina following childbirth. FINDINGS: Five hundred and twenty-four women were recruited to the survey in 1995. Vaginal loss, as reported by the women, was considerably more varied in duration, amount and colour than descriptions in current midwifery textbooks. The median number of days reported for the duration of vaginal loss was 21 days and the interdecile range (10th to 90th percentile) was 10-42 days. For colour of lochia, women overall reported their vaginal loss to be more predominantly red/brown in colour and the traditional descriptions of the timing and colour phases of lochia rubra, serosa and alba are not supported by the majority of the women's experiences. Primiparous women were significantly more likely to report feelings of surprise or shock about their experiences of vaginal blood loss after the birth (odds ratio 4 [95% Confidence Interval 2-9]). Seven primiparous women (2%) were unaware that they would have a blood loss at all after the birth. IMPLICATIONS FOR PRACTICE: The findings from this survey have been used to develop information leaflets for women and health professionals about vaginal loss following childbirth. These leaflets include descriptions of normal ranges for the colour, amount and duration of vaginal loss in the first three months after childbirth.

Adolescent↗