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Biomedical subjects

Matthew Hotopf

Publications and source records attributed to Matthew Hotopf.

At least 19 recordsLinked to original sources
PubMed2006

The inter-rater reliability of mental capacity assessments.

BACKGROUND: Assessing mental capacity involves complex judgements, and there is little available information on inter-rater reliability of capacity assessments. Assessment tools have been devised in order to offer guidelines. We aimed to assess the inter-rater reliability of judgements made by a panel of experts judging the same interview transcripts where mental capacity had been assessed. METHOD: We performed a cross sectional study of consecutive acute general medical inpatients in a teaching hospital. Patients had a clinical interview and were assessed using the MacArthur Competence Assessment Tool for Treatment (MacCAT-T) and Thinking Rationally About Treatment (TRAT), two capacity assessment interviews. The assessment was audiotaped and transcribed. The raters were asked to judge whether they thought that the patient had mental capacity based on the transcript. We then divided participants into three groups - those in whom there was unanimous agreement that they had capacity; those in whom there was disagreement; and those in whom there was unanimous agreement that they lacked capacity. RESULTS: We interviewed 40 patients. We found a high level of agreement between raters' assessments (mean kappa=0.76). Those thought unanimously to have capacity were more cognitively intact, more likely to be living independently and performed consistently better on all subtests of the two capacity tools, compared with those who were unanimously thought not to have capacity. The group in whom there was disagreement fell in between. CONCLUSIONS: This study indicates that clinicians can rate mental capacity with a good level of consistency.

Cardiovascular Diseases↗
PubMed2006

Mental health screening in armed forces before the Iraq war and prevention of subsequent psychological morbidity: follow-up study.

OBJECTIVE: To assess whether screening for mental disorder before the start of the 2003 Iraq war would have predicted subsequent mental disorders. DESIGN: Longitudinal cohort study of the United Kingdom armed forces. PARTICIPANTS: 2820 of 2873 personnel of the three services who completed an initial questionnaire in 2002 were asked to complete a second questionnaire between June 2004 and 2 March 2006. SETTING: Regiments, air stations, bases, ships, and homes for those who had left the services. MAIN OUTCOME MEASURES: Positive and negative likelihood ratios, and positive and negative predictive value of first assessment compared with assessment two to three years later of post-traumatic stress disorder, general health questionnaire, physical symptoms, self perception of health, and alcohol misuse for the entire group and for those deployed to the Iraq war. RESULTS: The response rate to the follow-up questionnaire was 69%, adjusted for return to senders. The positive likelihood ratio of post-traumatic stress disorder was high (13.1, 95% confidence interval 7.2 to 23.8), but the negative likelihood ratio was close to 1 (0.78, 0.67 to 0.91). The positive predictive values were low because of the low prevalence of post-traumatic stress disorder in the period before the Iraq war. The positive likelihood ratios for the other psychological assessments varied between 2.7 and 5.6, and the negative likelihood ratios were slightly lower than for post-traumatic stress disorder, indicating that these were not good candidates for screening. Results were the same for the analyses restricted to those who were deployed. CONCLUSIONS: Screening for common mental disorders before deployment in this cohort would not have reduced subsequent morbidity or predicted post-traumatic stress disorder, but this may change if there is a considerable increase in the prevalence of the disorder.

Cohort Studies↗
PubMed2006

Is there an Iraq war syndrome? Comparison of the health of UK service personnel after the Gulf and Iraq wars.

BACKGROUND: UK armed forces personnel who took part in the 1991 Gulf war experienced an increase in symptomatic ill health, colloquially known as Gulf war syndrome. Speculation about an Iraq war syndrome has already started. METHODS: We compared the health of male regular UK armed forces personnel deployed to Iraq during the 2003 war (n=3642) with that of their colleagues who were not deployed (n=4295), and compared these findings with those from our previous survey after the 1991 war. Data were obtained by questionnaire. FINDINGS: Graphs comparing frequencies of 50 non-specific symptoms in the past month in deployed and non-deployed groups did not show an increase in prevalence of symptoms equivalent to that observed after the Gulf war. For the Iraq war survey, odds ratios (ORs) for self-reported symptoms ranged from 0.8 to 1.3. Five symptoms were significantly increased, and two decreased, in deployed individuals, whereas prevalence greatly increased for all symptoms in the Gulf war study (ORs 1.9-3.9). Fatigue was not increased after the 2003 Iraq war (OR 1.08; 95% CI 0.98-1.19) but was greatly increased after the 1991 Gulf war (3.39; 3.00-3.83). Personnel deployed to the Gulf war were more likely (2.00, 1.70-2.35) than those not deployed to report their health as fair or poor; no such effect was found for the Iraq war (0.94, 0.82-1.09). INTERPRETATION: Increases in common symptoms in the 2003 Iraq war group were slight, and no pattern suggestive of a new syndrome was present. We consider several explanations for these differences.

Health Status↗
PubMed2006

The health of UK military personnel who deployed to the 2003 Iraq war: a cohort study.

BACKGROUND: Concerns have been raised about the mental and physical health of UK military personnel who deployed to the 2003 war in Iraq and subsequent tours of duty in the country. METHODS: We compared health outcomes in a random sample of UK armed forces personnel who were deployed to the 2003 Iraq war with those in personnel who were not deployed. Participants completed a questionnaire covering the nature of the deployment and health outcomes, which included symptoms of post-traumatic stress disorder, common mental disorders, general wellbeing, alcohol consumption, physical symptoms, and fatigue. FINDINGS: The participation rate was 62.3% (n=4722) in the deployed sample, and 56.3% (n=5550) in the non-deployed sample. Differences in health outcomes between groups were slight. There was a modest increase in the number of individuals with multiple physical symptoms (odds ratio 1.33; 95% CI 1.15-1.54). No other differences between groups were noted. The effect of deployment was different for reservists compared with regulars. In regulars, only presence of multiple physical symptoms was weakly associated with deployment (1.32; 1.14-1.53), whereas for reservists deployment was associated with common mental disorders (2.47, 1.35-4.52) and fatigue (1.78; 1.09-2.91). There was no evidence that later deployments, which were associated with escalating insurgency and UK casualties, were associated with poorer mental health outcomes. INTERPRETATION: For regular personnel in the UK armed forces, deployment to the Iraq war has not, so far, been associated with significantly worse health outcomes, apart from a modest effect on multiple physical symptoms. There is evidence of a clinically and statistically significant effect on health in reservists.

Cohort Studies↗
PubMed2006

Immunological dysfunction, vaccination and Gulf War illness.

One candidate cause of Gulf War illness is vaccination against infectious diseases including medical counter-measures against biological weapons. One influential theory has suggested that such mass-vaccination caused a shift in immune response to a Type 2 cytokine pattern (Th2), which it was suggested was accompanied by a chronic fatigue syndrome-like illness. This article critically appraises this theory. We start by examining epidemiological evidence, which indicates that single vaccines are unlikely to be a substantial cause of Gulf War illness, but that there was a modest relationship with multiple vaccines, which was strongest in those vaccinated while deployed to the Gulf. These relationships may be affected by recall bias. We conclude by examining the results of immunological studies carried out in veterans or in a relevant setting in vitro. The balance of evidence from immunological studies on veterans returning from the War, including those developing multi-symptom illness, is that the immune response has not become polarized towards Th2. In summary, the epidemiological evidence for a multiple vaccine effect on Gulf War-related illness remains a potentially important aetiological lead, but mechanistic studies available at this stage do not identify any immunological basis for it.

Cytokines↗
PubMed2006

UK armed forces responses to an informed consent policy for anthrax vaccination: a paradoxical effect?

BACKGROUND: In recognition of concerns that anthrax vaccination might be a trigger for "Gulf war syndrome", anthrax vaccinations were offered to UK armed forces in the 2003 Iraq conflict using explicit as opposed to implicit consent, as is the policy for all other vaccinations. This paper examines responses of personnel to this policy. METHODS: Qualitative analysis of free text responses to a question inviting comments on any concerns about the anthrax vaccination, asked in the context of a questionnaire assessing military health amongst 1000 members of the UK armed forces following the invasion of Iraq in 2003. RESULTS: Two hundred and two (20.2%) respondents made comments reflecting concerns about the vaccine's effectiveness and its safety. These appeared to be magnified by suspicions about the motives behind the informed consent policy for anthrax but not other vaccinations. CONCLUSION: While the informed consent policy for anthrax vaccinations was intended to decrease concern, it may inadvertently have had the opposite effect.

Anthrax Vaccines↗
PubMed2006

Early parental and child predictors of recurrent abdominal pain at school age: results of a large population-based study.

OBJECTIVE: To assess whether parental psychological and physical factors and child factors measured in the first year of life were associated with recurrent abdominal pain (RAP) in children at age 6(3/4) years. METHOD: A longitudinal cohort study (the Avon Longitudinal Study of Parents and Children), followed 8,272 children from pregnancy to age 6(3/4) years. Parental reports of child and parent functioning were gathered. Associations between parental and child functioning assessed at 6 to 8 months postpartum, and RAP measured at age 6(3/4) years were investigated. RESULTS: The prevalence of RAP in this sample was 11.8%. Both maternal anxiety (adjusted odds ratio = 1.53; 95% confidence interval 1.24-1.89) and paternal anxiety (adjusted odds ratio = 1.38; 95% confidence interval 1.12-1.71) in the first year of a child's life were associated with later childhood RAP. Parent reports of child temperament features such as irregular feeding and sleeping were also associated with later RAP. CONCLUSIONS: This is the first evidence from a prospective study that anxiety in both mothers and fathers and child temperament features predate the occurrence of RAP in children. These findings highlight the potential importance of addressing parental anxiety in families in which children present with RAP, although some caution should be exercised in their interpretation because of possible reporting bias.

Abdominal Pain↗
PubMed2006

Outcome of major depression in Ethiopia: population-based study.

BACKGROUND: The outcome and impact of major depression in developing countries are not clear. AIMS: To describe the outcome of major depression and compare the disability and patterns of service use among different outcome groups. METHOD: In a case cohort study, nested within a population-based survey of 68,000 participants using the Composite International Diagnostic Interview (CIDI), 300 participants were randomly selected from those with current major depression and 300 from those with no lifetime history. Participants were re-interviewed after 18-62 months to ascertain current diagnosis, psychological symptoms, disability and use of health services. RESULTS: Of participants with major depression at baseline 26% also met criteria for major depression at follow up. Mortality ratio standardised for age and gender was 3.55 (95% C11.97 to 6.39). All indices of measure of disability were significantly higher in the persistently depressed group compared with the completely recovered group. Participants who had recovered partially resembled participants with persistent depression. Two-thirds of those with persistent depression had not sought any help. CONCLUSIONS: Major depression was associated with mortality and disability. Those with residual symptoms remained disabled. Help-seeking was unusual.

Adolescent↗
PubMed2006

Are all antidepressants really the same? The case of fluoxetine: a systematic review.

OBJECTIVE: To systematically review the efficacy and tolerability of fluoxetine, the most widely studied of newer antidepressants, in comparison with all other antidepressants in the acute treatment of depression in patients aged more than 18 years. DATA SOURCES: Studies were identified through electronic searches of the Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Register and the Cochrane Central Register of Controlled Trials up to March 2004. The terms FLUOXETIN* OR adofen or docutrix or erocap or fluctin or fluctine or fluoxeren or fontex or ladose or lorien or lovan or mutan or prozac or prozyn or reneuron or sanzur or saurat or zactin were used. MEDLINE (1966-2004) and EMBASE (1974-2004) were searched using fluoxetine and randomized controlled trial or random allocation or double-blind method. No language restrictions were applied. Reference lists of relevant papers and previous systematic reviews were hand-searched for published reports up to March 2004. STUDY SELECTION: Only randomized controlled trials (either blind or nonblind) were included. DATA SYNTHESIS: 131 randomized controlled trials were eligible. A p value less than .01 was chosen to test the null hypothesis, and a 99% confidence interval was calculated to detect statistically significant differences with a high degree of confidence. Fixed- and random-effects relative risks, odds ratios (ORs), and Peto ORs were routinely calculated for each outcome measure. In terms of efficacy, we found a statistically significant difference favoring sertraline and venlafaxine over fluoxetine. In terms of tolerability, patients allocated to fluoxetine were less likely to leave the study early only in comparison with those allocated to amitriptyline and pramipexole. CONCLUSIONS: This systematic review highlighted that there are differences between fluoxetine and specific comparator antidepressants. Several of the differences met a prespecified criterion for clinical significance. The statistical approach adopted in this systematic review could represent a useful tool for putting clinical trial data into practice.

Adult↗
PubMed2005

Long-term mortality amongst Gulf War Veterans: is there a relationship with experiences during deployment and subsequent morbidity?

BACKGROUND: Gulf War Veterans have previously been shown to have, in the short-term, an excess risk of death from 'external' (i.e. non-disease) causes of death. This study aims to determine whether there remains an excess of non-disease-related deaths in Gulf Veterans, 13 years after deployment, and, for the first time, to determine whether there is a relationship between experiences reported in the Gulf, post-war symptoms, and subsequent mortality experience. METHODS: We conducted a cohort study with follow-up from April 1, 1991 (the end of the Gulf War) to June 30, 2004. Participants were 53 462 Gulf War Veterans and a cohort of military personnel, matched for age-group, sex, rank, service and level of fitness, who were not deployed to the Gulf. The outcome measure used was mortality as recorded on the NHS central register. RESULTS: There is no difference, 13 years after the end of the Gulf War, in the overall mortality experience of Gulf War Veterans. The excess in non-disease-related deaths previously reported is confined to the initial 7 years of follow-up [mortality rate ratio (MRR) 1.31, 95% confidence interval (CI) 1.06-1.63] rather than the more recent period (MRR 1.05, 95% CI 0.83-1.33). Overall experiences reported during Gulf deployment did not influence subsequent risk of dying, but there was non-significant increased risk of dying from a disease-related death (MRR 1.99, 95% CI 0.98-4.04) associated with reported exposure to depleted uranium and of a non-disease-related death associated with reporting handling of pesticides (MRR 2.05, 95% CI 0.91-4.61). Reporting of morbidity in the health surveys conducted was not related to future risk of death. CONCLUSION: The higher rates of non-disease-related deaths in Gulf War Veterans is not evident in the period of follow-up since 1997. Neither the excess morbidity reported in health surveys nor the experiences during deployment significantly influenced future mortality. The two non-significant associations found (reported depleted uranium exposure and disease death, reporting handling pesticides and non-disease deaths) need to be considered in the context of the number of possible associations examined and potential biases-although they are biologically plausible.

Adult↗
PubMed2005

Can epidemiology clear the fog of war? Lessons from the 1990-91 Gulf War.

Despite over US $200 million having been spent researching illnesses following the 1990-91 Persian Gulf War, the nature and cause of such illnesses remains controversial. In this narrative review, we discuss some of the methodological issues that have affected epidemiological studies on this topic. These include low-response rates, ascertainment bias, recall bias, problems identifying suitable control groups, and problems defining the outcomes to study. From this we argue that difficulties have arisen partly owing to the significant delay between the point at which illnesses were first identified by veterans and the reporting of epidemiological studies and that health surveillance should be routine following future deployments.

Congenital Abnormalities↗
PubMed2005

The relationship of fatigue to mental and physical health in a community sample.

BACKGROUND: Previous studies have shown fatigue and depression/anxiety to be highly associated with each other. The present study seeks to differentiate between fatigue and depression/anxiety and to investigate the familiality/heritability of fatigue using sib-pairs. METHOD: The GENESiS study is a questionnaire study based in the United Kingdom that includes a five-item fatigue scale and four mental health measures (GHQ-12, EPQ-N, MASQ-AA, MASQ-HPA). Fatigue data from 10,444 sibling pairs were analysed using multivariate methods and model fitting techniques to investigate the familiality/heritability of fatigue and its relationship with the other mental health measures and physical health items. RESULTS: Fatigue correlated highly with GHQ-12 (r=0.62, p<0.001). A principal components analysis of the fatigue scale and the GHQ-12 revealed one main component which correlated highly with mental health items, and a smaller second component which correlated modestly with physical health items. Fatigue showed a modest sibling correlation (0.09, p<0.001), and multivariate modelling revealed evidence for familial effects on fatigue that were independent of the mental health measures. CONCLUSIONS: Fatigue showed a strong relationship with both physical illness and mental health measures. Fatigue is modestly familial and at least part of this familial factor is not shared with mental health measures.

Adult↗
PubMed2005

What advice do patients with infectious mononucleosis report being given by their general practitioner?

OBJECTIVE: The aim of this study was to describe the advice that patients with acute infectious mononucleosis recall having been given by their general practitioner (GP; family or primary care doctor). METHODS: Individuals with a recent diagnosis of infectious mononucleosis were recruited for a randomised controlled trial assessing the effectiveness of a brief educational intervention on recovery. All participants were asked at their initial assessment what advice that they had been given by their GP. They were not given any prompts and were free to give several responses. Responses were grouped into various themes. RESULTS: Seventy-one patients took part. Of these, 11 (15%) recalled being given no specific advice. Of the remaining 60 participants, 70% recalled being given advice to rest, or to "take it easy", usually without any qualification; 10% recalled being given dietary advice, and 17% advice on simple symptom management. CONCLUSION: The majority of individuals with recent onset infectious mononucleosis recall being given advice to rest by their GPs. This finding is discussed in relation to evidence suggesting that rest may be unhelpful.

Diet↗
PubMed2005

Does ethnicity matter? Bereavement outcomes in two ethnic groups living in the United Kingdom.

BACKGROUND: Sociologists, anthropologists, and psychologists agree that grief is a universal phenomenon. Reactions to it are, however, socially constructed and patterned. OBJECTIVE: To compare the outcomes of bereavement among family or close friends of deceased first-generation black Caribbean and white native-born patients living in the United Kingdom. DESIGN: Comparative cross-sectional questionnaire survey in three inner London health authorities administered 10 months after the patient's death. PARTICIPANTS: Family and close friends of 50 deceased first-generation black Caribbean and 50 native-born white patients with advanced disease. MAIN OUTCOME MEASURES: 28-item General Health Questionnaire (GHQ-28), Core Bereavement Items scale, a 17-item measure of grief. RESULTS: The intensity of grief, measured using the Core Bereavement Items was similar between the two groups. Seventy-two respondents had visited their family doctor subsequent to bereavement, and of these, black Caribbean respondents reported more psychological problems. Depression and anxiety measured by the GHQ-28 were significantly higher among black Caribbean respondents (28.00 vs. 21.2) (t-test = -2.28, p = 0.025). Multiple regression analysis revealed this difference was best accounted for by bereavement concerns such as legal and housing problems. CONCLUSIONS: This study has observed higher psychological morbidity among the bereaved Caribbean individuals. Family doctors are a source of support for three-quarters of respondents, and they may need to focus on the needs of black and minority ethnic minorities.

Aged↗
PubMed2005

'Goodbye and good luck': the mental health needs and treatment experiences of British ex-service personnel.

BACKGROUND: Little is known about the psychological health or treatment experiences of those who have left the British armed forces. AIMS: To describe the frequency and associations of common mental disorders and help-seeking behaviours in a representative sample of UK veterans at high risk of mental health problems. METHOD: A cross-sectional telephone survey of 496 'vulnerable' ex-service personnel selected from an existing epidemiological military cohort. RESULTS: The response rate was 64%; 44% of these had a psychiatric diagnosis, most commonly depression. Those with a diagnosis were more likely to be of lower rank and divorced or separated. Just over half of those with self-reported mental health problems were currently seeking help, most from their general practitioners. Most help-seekers received treatment, usually medication; 28% were in touch with a service charity and 4% were receiving cognitive-behavioural therapy. CONCLUSIONS: Depression is more common than post-traumatic stress disorder in UK ex-service personnel. Only about half of those who have a diagnosis are seeking help currently, and few see specialists.

Adult↗