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Biomedical subjects

L Snowden

Publications and source records attributed to L Snowden.

13 recordsLinked to original sources
PubMed2006

Prevalence of environmental Aeromonas in South East Queensland, Australia: a study of their interactions with human monolayer Caco-2 cells.

AIMS: To investigate the prevalence of Aeromonas in a major waterway in South East Queensland, Australia, and their interactions with a gut epithelial model using Caco-2 cells. METHODS AND RESULTS: A total of 81 Aeromonas isolates, collected from a major waterway in South East Queensland, Australia, were typed using a metabolic fingerprinting method, and tested for their adhesion to HEp-2 and Caco-2 cells and for cytotoxin production on Vero cells and Caco-2 cells. Aeromonas hydrophila had the highest (43%) and Aeromonas veronii biovar sobria had the lowest (25%) prevalence. Four patterns of adhesion were observed on both HEp-2 and Caco-2 cell lines. Representative isolates having different phenopathotypes (nine strains) together with two clinical isolates were tested for their translocation ability and for the presence of virulence genes associated with pathogenic Escherichia coli. The rate and degree of translocation across Caco-2 monolayers varied among strains and was more pronounced with LogA pattern. Translocation was associated with the adherence of strains to Caco-2 cells microvilli, followed by internalization into Caco-2 cells. Two Aer. veronii biovar sobria strains were positive for the presence of heat-labile toxin genes, with one strain also positive for Shiga-like toxin gene. CONCLUSIONS: Pathogenic strains of Aeromonas carrying one or more virulence characteristics are highly prevalent in the waterways studied and are capable of translocating across a human enterocyte cell model. SIGNIFICANCE AND IMPACT OF THE STUDY: This study indicates that Aeromonas strains carrying one or more virulence properties are prevalent in local waterways and are capable of translocating in a human enterocyte cell culture model. However, their importance in human gastrointestinal disease has yet to be verified under competitive conditions of the gut.

Aeromonas↗
PubMed2001

The impact of realignment on utilization and cost of community-based mental health services in California.

Decentralization of California's public mental health system under program realignment has changed the utilization and cost of community-based mental health services. This study examined a sample of 75,951 users, representing 1.5 million adults who visited California's public mental health services during a 6-year period (FY 1988-1990 and FY 1992-1994). Regression analysis was performed to examine cost and utilization reduction over time, across regions, and across psychiatric diagnoses. Overall utilization and cost of community-based mental health services dropped significantly after the implementation of realignment. They were significantly lower for (a) 24-hour services in the urban industrialized Southern Region and (b) outpatient services in the agricultural Central Region of the state. Users diagnosed with mood disorders took a greater portion, but were associated with significantly less treatment and cost than other users in the post-realignment period. When local communities bear the financial risks and rewards, they find more efficient methods of delivering community-based mental health services.

Adult↗
PubMed2001

Persons with depressive symptoms and the treatments they receive: a comparison of primary care physicians and psychiatrists.

OBJECTIVE: To determine if demographic differences exist in patients with depressive symptoms as the principal reason for visits to primary care physicians (PCP) versus psychiatrists. To estimate the likelihood of these patients receiving a range of mental health services from each provider group. METHODS: Review and analysis of all outpatient visits made by patients with depressive symptoms using the National Ambulatory Medical Care Surveys (NAMCS) conducted in 1995 and 1996. RESULTS: A significantly greater proportion of visits by persons with depressive symptoms as the principal reason for visit were made to psychiatrists than to primary care physicians (T = -3.56, p = .000). However, men, African-Americans, other Non-White persons, and persons aged 65 to 74 and 75 years and over were proportionately more likely to visit a PCP than a psychiatrist. Women, whites, and persons aged 45 to 64 were proportionately more likely to make a visit to a psychiatrist than to a PCP. The overall intensity of care delivered by PCPs for patients with depressive symptoms was significantly lower than that provided by psychiatrists (t = -2.03, p = .02). Analysis of individual services also revealed significant differences in service provision. CONCLUSIONS: Demographic differences among the patient caseloads of these physician groups have implications for mental health service delivery because of known distinctions in prevalence rates, symptom presentation, and functionality among depressed patient subgroups.

Adolescent↗
PubMed2000

The effect of capitated financing on mental health services for children and youth: the Colorado experience.

OBJECTIVES: This study tested 2 propositions concerning the effect of capitated financing on mental health services for Medicaid-eligible children and youth in Colorado. The first is that capitation reduces costs. The second is that shifting providers from fee-for-service to capitated financing will increase their efforts to prevent illness. METHODS: Interrupted time-series designs were applied to a naturally occurring quasi experiment occasioned by the state of Colorado's reorganization of mental health services financing. RESULTS: The cost of services was significantly lower in counties with capitated services compared with counties with fee-for-service financing. Findings also suggested that economic incentives may lead to greater efforts at secondary and tertiary prevention. CONCLUSIONS: Policymakers and the public can expect that capitation will reduce the costs of children's mental health services below those likely with fee-for-service financing. Capitation per se, however, may not increase prevention as surely or swiftly as it lowers costs.

Adolescent↗
PubMed1997

Expressions of anxiety in African Americans: ethnography and the epidemiological catchment area studies.

High levels of anxiety have long been reported for African Americans. Recent analyses of Epidemiological Catchment Area (ECA) data have failed to support this, although contemporary ethnographies have discussed important African American folk idioms of anxiety. This study compares ethnographically reported symptoms of anxiety in African Americans to those reported in the ECA data. A multivariate analysis of female African American and European American differences in comparable ECA and ethnographic symptoms was performed. Significant differences were found not in ethnicity but in education levels. Alternative interpretations are discussed. Methodological problems are discussed highlighting limitations of both household survey research, such as the ECA project, and ethnography.

Black or African American↗
PubMed1997

An investigation into whether nursing student alter their attitudes and knowledge levels regarding HIV infection and AIDS following a 3-year programme leading to registration as a qualified nurse.

The purpose of this study was to examine whether a 3-year programme of nursing studies enabled nursing students to graduate from the course with greater knowledge and more positive attitudes towards HIV infection and AIDS than when they began the course. Students on a maths and information technology course were used as controls. The study involved the use of a questionnaire which gathered information about students' experience, knowledge, attitudes and moral judgement regarding HIV infection and AIDS. The experimental hypothesis stated that nursing students would show a greater increase in knowledge and positive attitude change towards HIV infection and AIDS than maths students. The results showed significant differences between third year nursing students' knowledge about HIV and AIDS when compared with other groups but it was noted that knowledge levels for all groups was quite low. There was no difference between first and third year nursing students' attitudes and moral judgement about HIV and AIDS but there was a significant difference between nursing students and maths students. It was suggested that there is a need to modify nurse education programmes in order to have greater impact on this topic area.

Adult↗
PubMed1997

Alcohol-related problems among black, Hispanic and white men: the contribution of neighborhood poverty.

OBJECTIVE: We examined the cross-sectional relationships between race/ethnicity, neighborhood poverty and alcohol-related problems among black, Hispanic and white male drinkers. Test hypotheses were that black and Hispanic men living in more impoverished neighborhoods would report increased numbers of alcohol-related problems than comparable white men. METHOD: Study hypotheses were tested in a sample of 744 black, Hispanic and white men participating in the 1992 National Alcohol Follow-up Survey. Study hypotheses were analyzed using generalized linear model regression analysis. RESULTS: Neighborhood poverty had a greater effect on alcohol-related problems in black than in white men, partially supporting our hypothesis. Black men living in more impoverished neighborhoods reported greater numbers of alcohol-related problems than comparable white men; there were no race differences among more affluent men. Neighborhood poverty had little effect on alcohol-related problems in Hispanic men. CONCLUSIONS: Findings suggest that, giving unfavorable economic conditions, black men will report greater numbers of alcohol-related problems than comparable white men.

Adult↗
PubMed1996

Managed care in the public mental health system.

The movement towards managed care in the public mental health system has surpassed efforts to develop a systematic literature concerning its theory, practice, and outcome. In particular little has been written about potential challenges and difficulties in translating managed care systems from their origins in the private sector to the delivery of public sector mental health services. This paper provides an overview of managed care definitions, organizational arrangements, administrative techniques, and roles and responsibilities using a theoretical framework adopted from economics referred to as principal-agent theory. Consistent with this theory, we assert that the primary function of the managed care organization is to act as agent for the payor and to manage the relationships between payors, providers, and consumers. From this perspective, managed care organizations in the public mental health system will be forced to manage an extremely complex set of relationships between multiple government payors, communities, mental health providers, and consumers. In each relationship, we have identified many challenges for managed care including the complexity of public financing, the vulnerable nature of the population served, and the importance of synchronization between managed care performance and community expectations for the public mental health system. In our view, policy regarding the role of managed care in the public mental health system must evolve from an understanding of the dynamics of government-community-provider-consumer "agency relationships".

Community Mental Health Services↗
PubMed1995

The California Adult Performance Outcome Survey: preliminary evidence on reliability and validity.

Recent legislation in California mandated the development of an outcome measure suitable for measuring changes in quality of life associated with treatment in the public mental health system. The measure, known as the California Adult Performance Outcome Survey (CAPOS), relies on clinician and client reports of objective and subjective indicators of quality of life. The present study sought to determine whether the clinician-administered CAPOS would agree with that administered by trained research assistants, and whether the CAPOS would agree with an established quality of life measure. A sample of sixty-four severely mentally ill subjects were assessed by their regular mental health provider using the CAPOS. One week later they were assessed by a trained research assistant using the CAPOS and Lehman's Quality of Life Interview (QOLI). For most outcome domains, the CAPOS exhibited moderate to excellent agreement across occasions and raters. Correlations with the QOLI indicated a good degree of overlap among corresponding domains. Outcome measurement procedures for routine use in clinical settings are in their infancy. The CAPOS appears promising in this role because of its brevity, ease of administration, and adequate interrater reliability. The CAPOS affords state and local mental health authorities with an efficient means of tracking key quality of life indicators within the public mental health system.

Activities of Daily Living↗