PubMed Health⌕ Search

Biomedical subjects

Paul White

Publications and source records attributed to Paul White.

At least 19 recordsLinked to original sources
PubMed2006

The psychometric properties of a psychosis screen in a correctional setting.

Many people who go to gaol are mentally ill. Remandees, prisoner receptions or people in jails have a substantially higher rate of severe mental disorder than other prisoners and the general population. There are no completely satisfactory ways to screen for psychosis and few existing screening questionnaires are available for use in correctional establishments. The Screening Instrument for Psychosis (PS) was developed in the context of the Australian Mental Health Survey: Study of Low Prevalence Disorders. It can help indicate whether a person should be referred to mental health professional for a diagnostic evaluation and possible treatment and/or diversion. We trialled the PS in a high security remand and reception centre. Measures of validity and reliability are reported.

Australia↗
PubMed2006

Randomized clinical trial of local anesthetic versus a combination of local anesthetic with self-hypnosis in the management of pediatric procedure-related pain.

A prospective controlled trial was conducted to compare the efficacy of an analgesic cream (eutectic mixture of local anesthetics, or EMLA) with a combination of EMLA with hypnosis in the relief of lumbar puncture-induced pain and anxiety in 45 pediatric cancer patients (age 6-16 years). The study also explored whether young patients can be taught and can use hypnosis independently as well as whether the therapeutic benefit depends on hypnotizability. Patients were randomized to 1 of 3 groups: local anesthetic, local anesthetic plus hypnosis, and local anesthetic plus attention. Results confirmed that patients in the local anesthetic plus hypnosis group reported less anticipatory anxiety and less procedure-related pain and anxiety and that they were rated as demonstrating less behavioral distress during the procedure. The level of hypnotizability was significantly associated with the magnitude of treatment benefit, and this benefit was maintained when patients used hypnosis independently.

Adolescent↗
PubMed2006

A comparison of Australian men with psychotic disorders remanded for criminal offences and a community group of psychotic men who have not offended.

BACKGROUND: People remanded into custody by the courts have a substantially higher rate of severe mental disorder than other prisoners and the general population. Knowledge of their prevalence, needs and characteristics and an analysis of pathways to care may be necessary to provide mental health care effectively and efficiently. Previous prison studies focusing on psychotic offenders have suffered from the use of instruments not validated in a forensic setting and lack of a relevant comparison group. METHOD: The Diagnostic Interview for Psychosis (DP) is a composite semi-structured standardized interview schedule. It combines social and demographic descriptors with measures of functioning adapted from the World Health Organisation Disability Assessment Schedule (DAS). The remand centre surveyed had 466 cells and is the main remand and reception centre for males for the southern region of the state of Queensland, Australia. Of the 621 men screened, 65 answered yes to at least one question in the DP and were interviewed. RESULTS: Six hundred and twenty-one remandees were screened and of these 61 were interviewed as screened positive for psychotic disorder. Thirty-five per cent had been homeless for an average of 32 weeks during the previous year. Most had had little contact with families or close friends. Eighty-one per cent were receiving no treatment at the time of offence. Seventy-eight per cent were unemployed and in receipt of a pension. Eighty per cent were dependent on alcohol, cannabis or amphetamines. Statistical issues of power are detailed in the text. CONCLUSIONS: The simplistic 'prison, hospital or community treatment' debate is misleading. Instead, the development of flexible preventative, management and accommodation services for people with severe mental disorder who have committed offences is a priority.

Adult↗
PubMed2006

Stress and burnout amongst professional carers of people with intellectual disability: another health inequity.

PURPOSE OF REVIEW: This paper summarizes trends in the research literature about stress and burnout in the lives of people who are the professional carers of people with intellectual disability. The principal time period considered was from 2004 to 2006. RECENT FINDINGS: Studies reviewed here focus on several themes including inequities affecting professional carers of people with intellectual disability and the possible effects of some models of care on inequities. Implications for people with intellectual disability are also considered. SUMMARY: The diaspora of people with intellectual disability into the community and their accompanying services found a whole new set of unpredicted and unprecedented challenges. Life in the community has rendered professional carers of people with intellectual disability more clearly vulnerable to stress and burnout for a variety of complex reasons, some identified and others as yet unrecognized. Lack of support and lack of role definition are particular problems. Presence of physical and mental health inequities result in major disparities in community care for people with intellectual disability.

Burnout, Professional↗
PubMed2006

Steady-state solutions to PBPK models and their applications to risk assessment I: Route-to-route extrapolation of volatile chemicals.

Although analysis of in vivo pharmacokinetic data necessitates use of time-dependent physiologically-based pharmacokinetic (PBPK) models, risk assessment applications are often driven primarily by steady-state and/or integrated (e.g., AUC) dosimetry. To that end, we present an analysis of steady-state solutions to a PBPK model for a generic volatile chemical metabolized in the liver. We derive an equivalent model that is much simpler and contains many fewer parameters than the full PBPK model. The state of the system can be specified by two state variables-the rate of metabolism and the rate of clearance by exhalation. For a given oral dose rate or inhalation exposure concentration, the system state only depends on the blood-air partition coefficient, metabolic constants, and the rates of blood flow to the liver and of alveolar ventilation. At exposures where metabolism is close to linear, only the effective first-order metabolic rate is needed. Furthermore, in this case, the relationship between cumulative exposure and average internal dose (e.g., AUCs) remains the same for time-varying exposures. We apply our analysis to oral-inhalation route extrapolation, showing that for any dose metric, route equivalence only depends on the parameters that determine the system state. Even if the appropriate dose metric is unknown, bounds can be placed on the route-to-route equivalence with very limited data. We illustrate this analysis by showing that it reproduces exactly the PBPK-model-based route-to-route extrapolation in EPA's 2000 risk assessment for vinyl chloride. Overall, we find that in many cases, steady-state solutions exactly reproduce or closely approximate the solutions using the full PBPK model, while being substantially more transparent. Subsequent work will examine the utility of steady-state solutions for analyzing cross-species extrapolation and intraspecies variability.

Area Under Curve↗
PubMed2006

Comparison of cancer slope factors using different statistical approaches.

The U.S. Environmental Protection Agency's cancer guidelines (USEPA, 2005) present the default approach for the cancer slope factor (denoted here as s*) as the slope of the linear extrapolation to the origin, generally drawn from the 95% lower confidence limit on dose at the lowest prescribed risk level supported by the data. In the past, the cancer slope factor has been calculated as the upper 95% confidence limit on the coefficient (q*1) of the linear term of the multistage model for the extra cancer risk over background. To what extent do the two approaches differ in practice? We addressed this issue by calculating s* and q*1 for 102 data sets for 60 carcinogens using the constrained multistage model to fit the dose-response data. We also examined how frequently the fitted dose-response curves departed appreciably from linearity at low dose by comparing q1, the coefficient of the linear term in the multistage polynomial, with a slope factor, sc, derived from a point of departure based on the maximum likelihood estimate of the dose-response. Another question we addressed is the extent to which s* exceeded sc for various levels of extra risk. For the vast majority of chemicals, the prescribed default EPA methodology for the cancer slope factor provides values very similar to that obtained with the traditionally estimated q*1. At 10% extra risk, q*1/s* is greater than 0.3 for all except one data set; for 82% of the data sets, q*1 is within 0.9 to 1.1 of s*. At the 10% response level, the interquartile range of the ratio, s*/sc, is 1.4 to 2.0.

Biological Assay↗
PubMed2005

Short- and long-term outcomes of using pulmonary allograft donors with low Po2.

BACKGROUND: The establishment of lung transplantation as a treatment modality for end-stage lung disease has led to an imbalance in the demand and supply for such a procedure. Increasingly marginal donors are being accepted for transplantation. We assessed the short- and long-term outcomes with the use of lung donors with low Po(2). METHODS: All heart-lung and double lung transplantations (n = 362) carried out between 1984 and 2001 were included. Recipients were divided according to the optimized donor Po(2) (on 100% Fio(2)): Po(2) = 30 to 40 kPa = low Po(2) donors (n = 50) and Po(2) >40 kPa = normal Po(2) donors (n = 312). There were no differences in the sex distribution, cytomegalovirus infection status, ischemic time, and intubation durations for the recipients and their respective donors between the 2 groups. The low Po(2) donors were older (38 vs 32 years, p = 0.01) and the allografts were transplanted into younger recipients (33 vs 38 years, p = 0.01). RESULTS: There was a trend toward an increase in the 30-day mortality between the 2 groups (22% vs 13%, odds ratio 1.92, 95% confidence interval 0.91-4.05 p = 0.08). The 1- and 5-year survival rates (standard error) were 66% (7%) and 52% (7%) for the low Po(2) group and 72% (3%) and 44% (3%) for the normal Po(2) group (p = 0.97). Similar infection rates were recorded for the groups. Although rejection rates were similar in the first 3 months, there was a lower rate of rejection in the low Po(2) group thereafter, (hazard ratio, 0.52; p = 0.05). Risk of bronchiolitis obliterans syndrome (BOS) onset was marginally increased in the borderline donors (hazard ratio 1.05, 95% confidence interval 0.68-1.62), although this was not statistically significant. CONCLUSIONS: Donor lung allograft, with optimized Po(2) between 30 and 40 kPa on 100% Fio(2), used for lung transplantation did compromise 30-day mortality, but the difference in mortality did not extend beyond 30 days in our patient group.

Adult↗
PubMed2005

Prevalence of intellectual disability and comorbid mental illness in an Australian community sample.

OBJECTIVE: The aim of this study was to bring to light the high prevalence of Australians affected by intellectual disability and comorbid serious mental illnesses. Results from a broad scale study are used to explore the reasons for this regularly overlooked phenomenon. METHODS: This study was based on secondary analysis of data collected in the national 'Disability, Ageing and Carers Survey, 1998'. The analysed data consisted of an Australian wide sample of 42 664 individuals living at home or in cared accommodation. Classification of intellectual disability and comorbid psychosis, anxiety and depressive disorder was based on the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10). RESULTS: The prevalence of intellectual disability in the sampled population was 1.25%. Of these people 1.3% had a psychotic disorder, 8% had a depressive disorder and 14% had an anxiety disorder that had been present for at least 6 months and was of such severity that it too was disabling. CONCLUSIONS: Findings indicate that people with intellectual disability are at high risk of developing comorbid serious mental illness. Dual diagnosis is however, often overlooked due to difficulties associated with establishing a diagnosis of a mental disorder in people with an intellectual disability, a problem which is heightened when the individual's capacity to participate in a clinical assessment is limited.

Adolescent↗
PubMed2005

A temporal-spatial analysis of bovine spongiform encephalopathy in Irish cattle herds, from 1996 to 2000.

This study investigated the distribution of bovine spongiform encephalopathy (BSE) in herds of cattle in Ireland over the years 1996 through 2000, prior to the introduction of widespread active surveillance. Mappings of index herds, herd density, and standardized morbidity ratios, by county, were employed to help visualize areas of potential clustering of BSE. The hypothesis of spatial clustering was tested using a spatial scan statistic applied to the location of the herd where exposure likely occurred. Both Bernoulli and Poisson spatial models indicated marked clustering of BSE herds centred on Monaghan county, with secondary clusters detected by Bernoulli approaches and some Poisson models in Wexford and Cork. The number of cases increased with time, but clear temporal-spatial clusters were rarely detected, except in the case of a cluster in Wexford. The focussed spatial scan analyses using the location of large-scale feed suppliers provided support for the hypothesis that clustering of BSE may be associated with feed source. The results of our analyses provided strong evidence in support of the hypothesis that herds, in which animals were most likely to have been exposed to the BSE agent, cluster geographically.

Animals↗
PubMed2004

Glucose-insulin infusion improves cardiac function during fetal tachycardia.

OBJECTIVES: The aim of this work was to study the effects of substrate deficiency and supplementation on cardiac function during fetal tachycardia. BACKGROUND: Although sustained fetal tachycardia may lead to cardiac failure and intrauterine death, neonatal tachycardia is generally better tolerated. Fetal myocardial energy production relies almost solely on glucose as substrate. We hypothesized that increased substrate availability by glucose-insulin (GI) infusion would improve fetal myocardial responses to tachycardia. METHODS: We used three porcine models: 1) an isolated fetal heart model; 2) an in vivo fetal model; and 3) an in vivo closed-chest neonatal model. Each animal was randomized to control or GI treatment during tachycardia. In model 1, the controls were perfused with conventional Krebs-Henseleit solution containing a glucose concentration of 5.5 mmol/l; the GI hearts received double glucose concentration and added insulin. In models 2 and 3, the GI animals received insulin in a 20% glucose solution. All hearts were exposed to 90 min of pacing at 250 to 330 beats/min. RESULTS: The isolated fetal hearts in the GI group showed no decline in dP/dt(max) during pacing, while the controls declined. In the in vivo fetal hearts, dP/dt(max) remained unchanged in the GI group and decreased significantly in the control group. Myocardial glycogen content was higher in the GI group than in controls. Functional indexes remained unchanged among both neonatal groups despite a higher glycogen content in the GI group. CONCLUSIONS: Glucose-insulin infusion during fetal tachycardia has a beneficial effect on myocardial metabolism and cardiac function. These observations may have direct clinical relevance to the management of fetal arrhythmia.

Animals↗
PubMed2004

Food of paradise: Tahitian breadfruit and the autocritique of European consumption.

In many ways, Tahiti was central to European colonialism, for it was there that European visitors forged a model of primitive nature that served as a comparison to, and sometimes critique of, European civilization. Tahiti was also the place from which a unique plant, the breadfruit, was brought to European colonies and to England and France during the late 18th century, at the behest of naturalists. With the breadfruit travelled contrasting perceptions of the Tahitian way of life. The autocritique of European lifestyles and the naturalization of the breadfruit are closely intertwined. The breadfruit indeed became a radical food of the end of the 18th century.

Artocarpus↗
PubMed2004

Variation in cadaveric organ donor rates in the UK.

BACKGROUND: Considerable variation exists in the organ donation rate between kidney retrieval areas (KRAs) within the UK. The causes for this are unknown. This study examines whether or not observed variations are correlated with various possible explanatory factors. METHODS: A geographical study involving Poisson regression analysis was carried out of all 21 KRAs in the UK in 1999 and 2000, with donor rate as dependent variable, and the following independent variables: road traffic accident, intracerebral haemorrhage and other trauma death rates; intensive care unit (ICU) bed numbers; co-location of transplant and neurosurgical units; population ethnicity; proportion of the population on the organ donor register; transplant coordinator numbers; and transplant unit numbers. Main outcome measures were: donor rate in each KRA; strength of association between independent and dependent variables; and magnitude of changes in the donor rate associated with changes in independent variables. RESULTS: The donor rate varied between eight and 27.4 donors per million population per year. There was an association between donor rate and general ICU bed numbers (more beds associated with a higher donor rate), but this was of borderline statistical significance (P = 0.065). However, the donor rate was negatively associated (P = 0.02) with neurosurgical ICU bed numbers (more beds, fewer donors) and the proportion of the population from minority ethnic communities. There was no statistically significant association with the other independent variables. CONCLUSIONS: There is significant variation in the organ donor rate between different parts of the UK. More research is needed to explore the counter-intuitive association between neurosurgical ICU beds and donations, and to determine the remaining causes of the observed variation.

Adolescent↗
PubMed2004

Altered body image: appearance-related concerns of people with visible disfigurement.

AIM: The aim of this paper is to report a study to establish the extent and type of psychosocial needs of outpatients attending for treatment of a wide range of disfiguring conditions. BACKGROUND: Visible disfigurements can be associated with extensive psychosocial difficulties. The majority of research to date has been carried out with people identified by themselves or others as experiencing difficulties. Little is known about levels of distress in the broader population of patients receiving treatment for a range of disfiguring conditions. METHODS: A cross-sectional survey was conducted, with a convenience sample. Participants (n = 458) drawn from 15 outpatient clinics completed standardized measures of anxiety and depression (Hospital Anxiety and Depression Scale), social anxiety and avoidance (Derriford Appearance Scale short-form) and quality of life (World Health Organization Quality of Life Brief Scale). A semi-structured interview was used to generate further quantitative and qualitative data about individual concerns, and satisfaction with the provision of care. Staff views about levels of psychosocial distress were elicited through group discussions. RESULTS: The results revealed high levels of psychological distress in the sample, compared with normative values. The majority of difficulties related to problems experienced in social situations. Patient satisfaction with care was generally high; however, and 71% of participants expressed a moderate to strong desire for a health care professional with training to deal with their appearance-related concerns. Nursing staff felt unable to address patients' appearance-related difficulties because of time constraints, lack of an environment conducive to the discussion of patients' concerns, and lack of appropriate knowledge and training. CONCLUSION: A significant proportion of participants experienced psychosocial distress in relation to their visible difference. Psychosocial needs were poorly met in current outpatient care provision, and a range of options could be considered to address these more effectively.

Adolescent↗
PubMed2002

The effectiveness of cognitive-behavioural interventions provided at Outlook: a disfigurement support unit.

RATIONALE, AIMS AND OBJECTIVES: The establishment and evaluation of a disfigurement support unit (Outlook), based in a district general hospital is described. METHODS: The effectiveness of cognitive-behavioural interventions provided for 36 adults referred from a range of specialties was evaluated through the use of semistructured interviews, and standardized and visual analogue scales completed at initial assessment, at the end of intervention and at 6 months follow-up. RESULTS: There were significant improvements on all measures at the end of intervention, which were maintained at 6-month follow-up, including social anxiety, appearance-related distress, general anxiety and depression. Clients also reported significant improvements in positive affect and satisfaction with life. They felt more confident with strangers and in dealing with new social situations. In addition, their perceptions of the noticeability of their condition, both to themselves and to others, had significantly reduced. Dendograms revealed two distinct groupings of clients, with one group showing greater improvements following intervention. CONCLUSIONS: The results suggest that Outlook represents a valuable addition to the current provision of surgical and medical care.

Adolescent↗