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Biomedical subjects

M Farrell

Publications and source records attributed to M Farrell.

At least 19 recordsLinked to original sources
PubMed1998

Socioeconomic status, standard of living, and neurotic disorder.

BACKGROUND: Evidence on the association between socioeconomic status and the prevalence of neurotic disorder is contradictory. We studied the association between three elements of socioeconomic status and the prevalence of neurotic psychiatric disorder in a representative sample of adults aged 16-64 living in private households in the UK. METHODS: A cross-sectional survey of 10,108 adults aged 16-65 resident in private households in the UK was selected by a multi-stage, clustered, random-sampling design. Neurotic disorders were defined using a standardised interview, the revised clinical interview schedule (CIS-R). Data for 9570 people were available for this study. FINDINGS: We used housing tenure and access to cars as measures of standard of living; both were associated with the prevalence of neurotic disorder even after adjustment for other socioeconomic and demographic variables, including Registrar General's Social Class and educational attainment. Those people with no access to a car had an odds ratio for neurotic disorder of 1.4 (95% CI 1.1-1.7), compared with those who had access to two or more cars. People who rented their homes were also at increased risk (1.3 [1.1-1.5]). We estimated that about 10% of the neurotic disorder in the UK could be attributed to the increased prevalence of those without cars who rented their homes. There was a complex interaction between Registrar General's Social Class and sex, and there was no independent association with educational attainment. INTERPRETATION: There is an independent association between low standard of living and the prevalence of neurotic psychiatric disorder. The UK has experienced one of the largest increases in income inequality within western market economies over the past 20 years, and this inequality may have had adverse consequences for the mental health of the population.

Adolescent↗
PubMed1998

MCP-1, MCP-2 and MCP-3 expression in multiple sclerosis lesions: an immunohistochemical and in situ hybridization study.

Chemokines are low molecular weight chemotactic cytokines that have been shown to play a central role in the perivascular transmigration and accumulation of specific subsets of leukocytes at sites of tissue damage. Two major families have been defined depending on the positioning of four conserved cysteines. The CXC chemokines predominantly attract neutrophils, whereas the CC chemokines predominantly attract monocytes and other leukocyte cell types. Members of the monocyte chemotactic protein (MCP)-1 family form a major component of the CC family of chemokines and are considered the principal chemokines involved in the recruitment of monocytes/macrophages and activated lymphocytes. In this study we addressed the expression and distribution of MCP-1, -2 and -3 in multiple sclerosis (MS) lesions of differing ages and levels of inflammatory activity using immunohistochemistry and in situ hybridization. In acute and chronic-active MS lesions immunoreactivity for MCP-1, -2 and -3 was prominent throughout the lesion center with reactivity diminishing abruptly at the lesion edge. Hypertrophic astrocytes were strongly reactive and inflammatory cells showed variable reactivity. Outside of the lesion only hypertrophic astrocytes were reactive. The results obtained by in situ hybridization for MCP-1 were in agreement with those obtained by immunostaining. In more chronic lesions immunoreactivity for MCP-1, -2 and -3 was considerably diminished, and in chronic-silent lesions immunoreactivity was restricted to a few scattered reactive astrocytes. Normal control brains showed no immunoreactivity for MCP-1, -2 and -3. Although the cellular distribution of all three members of this family was similar, antibodies to MCP-3 gave prominent staining of the extracellular matrix that was not noted for MCP-1 and -2. These results support the conclusion that members of the MCP family of chemokines are involved in the development of MS lesions in the central nervous system.

Adult↗
PubMed1998

The influence of age and sex on the prevalence of depressive conditions: report from the National Survey of Psychiatric Morbidity .

BACKGROUND: Women are consistently reported to have a greater prevalence of depressive disorders than men. The reason for this is unclear, and is as likely to be social as biological. There is some evidence that the excess of depression is greater during women's reproductive lives. Data from the National Survey of Psychiatric Morbidity were used to test the hypothesis that the excess disappeared in the post-menopausal years and that obvious social explanations for this were inadequate. METHOD: Subjects (N = 9792) from a random sample of the British population provided data for the analysis. Psychiatric assessment was carried out by lay interviewers using the CIS-R. Subjects with ICD-10 depressive episode or mixed anxiety/depression were compared with the remainder. Social variables that were likely to contribute to a post-menopausal decline in depressive disorders were controlled in logistic regression analyses. RESULTS: There was a clear reversal of the sex difference in prevalence of depression in those over age 55. This could not be explained in terms of differential effects of marital status, child care, or employment status. CONCLUSIONS: This large and representative survey adds considerably to the increasingly held view that the sex difference in prevalence of depression is less apparent in later middle age. This may be linked to the menopause, and our attempts to explain it in terms of obvious conditions among social variables were not successful. More specific studies are required to clarify the finding.

Adolescent↗
PubMed1998

Hearing the voices of women in war through continuous quality improvement.

During the war in Bosnia-Herzegovina (BIH), the infrastructure of the health care system was destroyed and health officials, health care providers, and women experienced the war from their own perspectives. Using the principles of continuous quality improvement (CQI), these perspectives were honored and served as the basis for an international training program to hear the voices of women in war and the concerns of those who cared for them. With the results of a comprehensive national survey of all partners, the World Health Organization's European Regional Office held a five-day workshop that used CQI methods. The facilitators and 18 nurses, midwives, and physicians from six cantons developed interventions to address the women's needs, as detailed from the women's stories and from the professional perspectives of governmental authorities and health providers. The effort illustrates the ways in which the principles and tools of CQI can be used to capture the needs of the users of the services with those responsible for restructuring the health service and those with overall responsibility for the health of woman throughout the country.

Bosnia and Herzegovina↗
PubMed1998

Care tracker: a new approach to nursing care in ambulatory settings.

The shift from inpatient to ambulatory settings and the increasingly large and diverse numbers of ambulatory clients require reengineering and cost-effective approaches to managing ambulatory care. With data on 921 encounters in 12 ambulatory clinics, we developed CARE TRACKER, an instrument to describe nursing encounters by type, intervention, staff, time, and cost. Distinguishing nursing from medical interventions is an appreciable improvement over the traditional practice of bundling nursing as part of overhead costs. If managers can track the care delivered, they can better calculate staffing requirements, staff mix, inservice needs, and the costs of their existing and projected services.

Ambulatory Care↗
PubMed1997

v-Rel prevents apoptosis in transformed lymphoid cells and blocks TNFalpha-induced cell death.

The v-Rel oncoprotein belongs to the Rel/NF-kappaB family of transcription factors. It transforms chicken lymphoid cells in vitro and induces fatal lymphomas in vivo. In this study, we used a tetracycline-regulated system to characterize the role of v-Rel in cell transformation. We show that the continued expression of v-Rel is necessary to maintain the viability of transformed lymphoid cells and enables primary spleen cells to escape apoptosis in vitro culture. In agreement with a possible role for v-Rel in the inhibition of programmed cell death, its inducible expression in HeLa cells prevented TNFalpha-induced apoptosis. While the repression of v-Rel was accompanied by the rapid degradation of IkappaBalpha, changes in the steady-state levels of the apoptosis inhibitors Bcl-2 and Bcl-X(L) were only observed following the onset of cell death in transformed lymphoid cells. This suggests that the anti-apoptotic activity of v-Rel may affect other apoptosis inhibitors or other factors in the death pathway. Together, these findings demonstrate that v-Rel blocks apoptosis and suggest that this activity may be an important component of its transforming function.

Animals↗
PubMed1997

Developing a radiology data base for quality assurance.

Radiology Information Systems (RIS) are designed to capture and manage the data associated with ordering, executing, reporting, and billing x-ray procedures. The HELP Hospital Information System contains a radiology subsystem that supports these functions. In an effort to enhance quality assurance initiatives, we have created a supplemental data base. This data base contains not only the data traditionally generated by RISs but also data from the hospital system that is relevant to quality assurance. One of the goals associated with this data base is to use techniques from the discipline of Continuous Quality Improvement (CQI) in the radiology department. A focus of our initial efforts has been the time necessary to provide x-ray reports to ordering physicians once the imaging examination has been performed. Efforts to manage the portion of this time interval caused by transcription have resulted in a substantial decrease in the time required for this function. A second goal of this project is to evaluate the quality of x-ray ordering. This objective requires a computerized record of the outcome of the x-ray procedure. Initial analysis of data derived from this data base indicates significant differences in the ordering behavior for computed tomography (CT) examinations among a test group of physicians. A third goal is to do quality assurance on x-ray reports. Experience with pilot systems has shown promising results using a mathematical model of report quality. We hope to leverage these techniques and this quality assurance data base to define a COI process for medical reports in general and for x-ray reports in particular.

Database Management Systems↗
PubMed1997

Time of day of methadone consumption and illicit heroin use.

One hundred clients receiving methadone substitution treatment participated in an investigation of the relationship between methadone dose, time of daily self-administration and reported illicit heroin and other drug use. The study was conducted at two outpatient clinics operating from a single site at the Maudsley Hospital, London. Forty-seven per cent of clients reported using illicit heroin on one or more occasions in the week before interview. Multivariate analysis of methadone dose, time of methadone administration and duration of treatment indicated that the time of methadone administration was the most important predictor of illicit heroin use. Clients who took their methadone before 1500 h were less likely to use heroin than those who consumed methadone later in the day. This finding suggests the possibility of reducing illicit heroin use by methadone maintenance clients through the structuring of treatment programmes so that supervision of methadone consumption occurs during the early part of the day.

Adult↗
PubMed1997

The National Psychiatric Morbidity surveys of Great Britain--initial findings from the household survey.

BACKGROUND: This paper describes the Household Survey from the National Survey of Psychiatric Morbidity. This covered a sample drawn at random from the population of Britain, with the exception of the Highlands and Islands of Scotland. METHODS: The Postcode Address file was used as the sampling frame. Nearly 13000 adults aged 16-65 were selected for interview, of whom 10108 (79.4%) were successfully interviewed. Eight per cent could not be contacted and 13% refused interview. Psychiatric assessment was carried out by lay interviewers using the CIS-R. Subjects were also screened for psychosis, and screen-positive individuals were examined by psychiatrists using SCAN. RESULTS: Sixteen per cent of subjects scored above the standard cut-off of 12 on the CIS-R. The overall 1-week prevalence of neurotic disorder was 12.3% in males and 19.5% in females. Unmarried and post-marital groups had high rates of disorder, as did single parents and people living on their own. Respondents in Social Class I had notably lower rates of neurotic disorder than the remainder of the sample. Unemployment was strongly associated with disorder. Subjects living in urban areas had a higher overall prevalence, but there was no significant variation by region. Black respondents had higher rates of disorders that were entirely explained by their age, family type and social class. Individual neurotic disorders were all significantly commoner in women, with the exception of panic disorder. The 1-year prevalence of functional psychoses was 4 per 1000, with no sex difference. Alcohol and drug dependence was considerably more prevalent in men. CONCLUSIONS: For the first time, the survey provides data on the prevalence and correlates of psychiatric disorder on a nationwide sample that can be used to inform equitable and effective national psychiatric services.

Adolescent↗
PubMed1997

The National Psychiatric Morbidity surveys of Great Britain--strategy and methods.

BACKGROUND: This paper describes the rationale and methodology of the first national psychiatric morbidity surveys to be carried out in Great Britain. The objectives of the surveys were to estimate the prevalence of psychiatric morbidity among adults aged 16-64 living in Great Britain; to identify the nature and extent of social disabilities associated with psychiatric morbidity; to describe the use of health and social services by people with psychiatric morbidity and to investigate the association between mental illness and potential environmental risk factors in a household sample. METHODS: Four separate surveys were carried out in order to meet the objectives; a private household sample (N = 10108), a sample of institutions caring for the mentally ill (N = 1191), a sample of homeless people (N = 1166), and a supplementary sample of patients with psychosis living in private households (N = 350). A two-stage assessment procedure was used, in which all subjects were given the Revised Clinical Interview Schedule (CIS-R) administered by lay interviewers to assess neurotic symptoms and disorders and a psychosis screen, including the Psychosis Screening Questionnaire. Those who were positive on the psychosis screen were then interviewed by psychiatrists using the SCAN (incorporating the tenth edition of the Present State Examination). CONCLUSIONS: Large scale national surveys such as this augment the inadequate data on psychiatric morbidity that are routinely available and are, therefore, an important source of information upon which to base policy and generate aetiological hypotheses. These surveys provide a possible model for similar surveys in other countries.

Adolescent↗
PubMed1997

Lipoprotein (a): a potential biological marker for unruptured intracranial aneurysms.

OBJECTIVE: The diagnosis and treatment of intracranial aneurysms (IAs) prior to rupture reduces the high morbidity and mortality associated with their occurrence. Elevated serum lipoprotein (a) [Lp(a)] level, an independent risk factor for atherogenesis, has been demonstrated in sporadic IA disease (1). The purpose of this study was to assess the degree of correlation between elevated Lp(a) levels and the occurrence of IAs in asymptomatic first degree relatives of index cases from three families exhibiting a familial tendency towards IA development. METHODS: 25 family members and 41 healthy controls were screened by random serum Lp(a) sampling. All family members received 4-vessel cerebral angiography. RESULTS: Eleven family members were found on angiography to harbour asymptomatic aneurysms and all were successfully treated by surgery. Of these 11, ten had significantly raised serum Lp(a) levels (> 30 mg%). Fourteen family members had negative angiograms. Eight of this latter group, mean age 43.6 +/- 3.8 years, had serum Lp(a) levels above the normal range. Mean Lp(a) levels were 53.7 +/- 1.2 mg% in subjects with aneurysms compared with 22.1 +/- 1.45 mg% in subjects without demonstrable aneurysms and 10.5 +/- 0.48 mg% in the control population. CONCLUSION: The prevalence of elevated Lp(a) levels in these families and the high degree of association of raised Lp(a) levels with the presence of IAs in several family members warrants follow up of angiographically negative young subjects. We require a case-control study to establish whether particular polymorphisms at the apoprotein (a) gene level are associated with the occurrence of IAs in these families.

Adult↗
PubMed1997

Fatal methadone and heroin overdoses: time trends in England and Wales.

STUDY OBJECTIVE: Although the total number of self poisonings in England and Wales has dropped by 32%, the number involving methadone and/or heroin rose by 900% in 1974-92. Because of concern about the role of methadone in this increase, the part played by methadone and heroin in poisoning deaths in England and Wales in 1974-92 was investigated. DESIGN: A proportional mortality design was used to study whether the ratio between deaths involving methadone or heroin and other substances had increased. The time trend was examined with logistic regression. SETTING: England and Wales, 1974-92. SUBJECTS: Accidental, undetermined, and suicidal poisoning deaths (n = 43,231). MAIN RESULTS: The proportions of poisoning deaths involving methadone (alone or in combination with heroin) rose by 80% (95% CI 69%, 92%) per 3 year period. The proportion of poisoning deaths involving heroin without methadone rose by 76% (95% CI 60%, 93%) per 3 year period. Similar results were obtained when poisoning deaths were examined in relation to gender and legal category (suicide and undetermined versus accidental deaths). CONCLUSIONS: The impact of opiate addiction on rates of death by poisoning is rising quickly. This may reflect the growth of the addict population and is an important public health problem. There is no evidence that methadone's involvement in these deaths has risen disproportionately in relation to that of heroin up to 1992.

Accidents↗
PubMed1997

Effect of cyclophosphamide on leukocytic infiltration in the brain of MRL/lpr mice.

Neuropsychiatric manifestations are a poorly understood and potentially life-threatening complication of systemic lupus erythematosus (SLE). MRL/lpr mice spontaneously develop a lupus-like syndrome which is similar to the human disease in many respects, including behavioural abnormalities. Our previous findings indicated that the age at which infiltration of immune cells into the choroid plexus is first observed coincides with the appearance of behavioural dysfunction in MRL/lpr mice. This present study quantified leukocyte infiltration in relation to prolonged administration of cyclophosphamide (CY), a treatment effective in preventing some behavioural deficits. Compared to MRL +/+ controls, saline-treated MRL/lpr mice had significantly more CD45-positive cells (leukocytes) and CD45R-positive (B) cells in the choroid plexus and in the brain parenchyma. A six week course of CY (100 mg/kg i.p.) significantly reduced the infiltration of CD45, but not of CD45R-positive cells into the choroid plexus of the MRL/lpr substrain. In addition, the presence of leukocytes correlated positively with measures on one behavioural test (floating in the forced swim test) but not on another test (novel object test). These findings suggest that CY treatment has a differential effect on the infiltration of leukocyte subtypes and strengthen the hypothesis that some abnormal behaviour in MRL/lpr mice may be related to the presence of immunocompetent cells in the brain.

Animals↗