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Biomedical subjects

R Littlewood

Publications and source records attributed to R Littlewood.

At least 19 recordsLinked to original sources
PubMed2006

Mental health and intellectual disability: culture and diversity.

BACKGROUND: Compared with that in mental illness, cultural variation in popular conceptualisations of intellectual disability has been rarely addressed. METHODS: A survey of the relevant literature was conducted. RESULTS AND CONCLUSION: Preliminous conclusions are that local conceptualisation does not lead to invariant social response, but that intellectual disability is generally distinguished from mental illness.

Cross-Cultural Comparison↗
PubMed2005

A postmarketing surveillance study of the safety and efficacy of ReFacto (St Louis-derived active substance) in patients with haemophilia A.

This clinical trial evaluated the safety and efficacy of ReFacto (St Louis-derived active substance) in patients with severe or moderately severe haemophilia A over a period of 6 months or 50 exposure days (EDs), whichever occurred first. Sixty patients, 58 previously treated and two previously untreated, were enrolled into this study. This was an open-label, multicentre, postmarketing surveillance study in which patients received prophylaxis or on-demand treatment as determined by their doctor. Surgical prophylaxis was evaluated in seven patients requiring elective surgery. Thirty-two patients aged <1 to 66 years (median 19.5) received prophylaxis and 28 patients, aged 1-71 years (median 33.5), received on-demand treatment. The majority of patients had severe haemophilia A (FVIII:C < 2%): 84.4% in the prophylaxis group and 85.7% in the on-demand group. Prophylaxis with ReFacto was associated with a median of 6.7 bleeds per year (range: 0-37). The investigator's assessment of final outcome for prophylactic treatment was excellent or effective for 93.1% of patients. ReFacto resolved 92.8% of bleeds with one or two infusions. The investigator's assessment was excellent or good for 98.2% of bleeds treated with ReFacto. Haemostasis was achieved for all seven surgical cases and ReFacto gave an excellent or good response for each. The nature and incidence of adverse events was as expected and no new safety concerns emerged. One previously treated patient (PTP) developed a high-titre inhibitor (maximum 75 BU) and one minimally treated patient (MTP) developed a low-titre inhibitor while on the study but eventually achieved high titres (maximum 30 BU) after immune tolerance therapy was initiated with a plasma-derived FVIII product. One previously untreated patient (PUP) developed a transient low-titre inhibitor (0.4 BU). Other serious adverse events (SAEs) were unrelated to study treatment. There were no allergic events. The results of this study are consistent with the previously published ReFacto pivotal studies.

Adolescent↗
PubMed2001

Psychotherapy in cultural contexts.

This article examines gender politics, culture, and race, as well as therapy and social transition, as they relate to psychotherapy in cultural contexts. Examples of gender politics in Kenya and Somalia are discussed. Rites of passage as they relate to psychiatric illness also are discussed. "Therapeutic cure" as defined in various cultures also is reviewed.

Cross-Cultural Comparison↗
PubMed2001

Against over-interpretation: the understanding of pain amongst Turkish and Kurdish speakers in London.

The understanding of experienced pain has recently moved from the biological to the metaphorical. Detailed interviews with twelve Turkish and Kurdish patients in London who had been unsuccessfully investigated medically for chronic pain showed that their understanding reflected local, typically humoural, conceptions of self and body. However there was little to suggest interpretation of the illness as a more specific and grounded idiom for social or political experience. It is suggested that the current vogue for 'interpretation' in medical anthropology and social psychiatry may occasionally be, as Umberto Eco puts it, 'over-interpretation'.

Adult↗
PubMed2001

Social institutions and psychological explanations: Druze reincarnation as a therapeutic resource.

For Emile Durkheim, to explain our social institutions through individual psychology was generally regarded as illegitimate. It has, however, often been assumed by psychologists and psychiatrists, particularly in the case of religious doctrine and institutions. However, the people actually concerned, our religious informants, might sometimes themselves volunteer interpretations which are psychologically functional for the origin and maintenance of certain cultural facts. This is particularly so when they are faced with a 'modern' worldview. The instance of the Druze belief in bodily reincarnation after death is considered in the context of the recent civil war in the Lebanon.

Adult↗
PubMed1999

Perceptions about mental illness among pre-clinical medical students in Trinidad & Tobago.

Perceptions about mental illness among medical practitioners are likely to determine their capacity to recognise, treat appropriately and refer patients who have mental health problems. It is therefore important that training of medical students in psychiatry is undertaken with knowledge of their attitudes to mental health disorders. We determined the perceptions of 108 pre-clinical medical students (69 males, 39 females; mean age 22 years) toward mental illness in Trinidad & Tobago by analysing their responses to a questionnaire based on a case vignette of a young man with a paranoid psychotic illness. 88% felt that medical treatment in hospital was the best means of treating the illness and 86% suggested that discharge should be conditional on regular visits to a doctor. 89% however opposed the patient's marrying into their families and 85% to his teaching their children. This was associated significantly with having a personal relationship with someone having a mental illness (p < 0.03). Surprisingly, 25% believed that mental illness could be caused by supernatural forces, particularly females who were almost twice as likely as males to express this belief.

Adult↗
PubMed1998

Patient satisfaction: ethnic origin or explanatory model?

Despite concern over their psychiatric treatment, little is known about black and ethnic minority patient satisfaction with psychiatric services and whether perceived 'ethnicity' or discrepant understanding of illness experience is most relevant. Twenty-one white British and 63 ethnic minority patients were interviewed for their opinions on psychiatric in-patient care, their treatment preferences and their explanatory models of their illness. The most significant association with satisfaction was not ethnic origin but the patient's explanatory model of their illness which showed little association with ethnicity whether patients were voluntary or involuntary. Satisfaction is most likely when there is concordance between the patient's and psychiatrist's explanatory model.

Adult↗
PubMed1997

The effects of two doses of replacement growth hormone on the biochemical, body composition and psychological profiles of growth hormone-deficient adults.

This study examined the effects of growth hormone (GH) replacement on the insulin-like growth factor-I (IGF-I), body composition and psychological profiles of GH-deficient adults. We assessed whether two doses of GH produced different effects on these variables and whether patients who, at the end of the study chose to remain on long-term GH replacement responded differently to those who chose to abandon therapy. Forty-two adults (aged 42.9 +/- 1.9 years (mean +/- S.E.M.)) with documented GH deficiency entered two studies (24 in study 1, 18 in study 2). Biochemical, body composition and psychological profiles were assessed at baseline, and after 6 months and 1 year. Psychological assessments were performed using well-established, independent, validated 'Quality of Life' questionnaires (Nottingham Health Profile (NHP) and the Psychological General Well-Being Schedule (PGWB)). The study protocols differed only in the doses of growth hormone (0.024 mg/kg per day and 0.012 mg/kg per day respectively). Comparison between studies and between patients eventually continuing and abandoning GH therapy was performed. GH replacement was associated with significant changes in IGF-I levels (P < 0.001), body composition (P < 0.01) and self-perceived well-being (NHP, P < 0.01; PGWB, P < 0.01). The higher dose of GH produced a greater IGF-I response than the lower dosage (44.6 +/- 7.3 vs 26.2 +/- 3.6 nmol/l, P < 0.05), but no better psychological response (NHP, P = 0.22; PGWB, P = 0.23). Those deciding to continue replacement therapy did not respond differently to those choosing to abandon therapy with respect to IGF-I (P = 0.72), body composition (P = 0.38) and psychological assessment (NHP, P = 0.29; PGWB, P = 0.24). GH replacement in GH-deficient adults was associated with significant improvements in self-perceived well-being as well as changes in body composition and other variables. This improvement was similar at two different doses of replacement GH. Those patients electing to continue on long-term replacement did not achieve a demonstrably different psychological, body composition or biochemical benefit to those patients deciding to discontinue replacement.

Adolescent↗
PubMed1996

Vision testing in atrophic macular degeneration.

PURPOSE: To determine the correlation between a group of vision tests in atrophic macular degeneration (AMD) in an office setting. METHODS: Patients with documented vision loss from atrophic macular degeneration in one eye were invited to attend an eye clinic every three months for a series of six vision tests for their good eye followed by fundus photography. Modified contrast sensitivity, blue/yellow anomaloscopy, flicker fusion frequency, Amsler grid, and photostress recovery time were correlated with Snellen acuity using the Pearson correlation coefficient. The regression of the Snellen acuity on sex, age and the presence of disciform macular degeneration in the other eye was obtained using a general linear model. RESULTS: The correlation with Snellen acuity result was low for all tests. It was highest for Amsler grid abnormality (r = -0.33345) and blue/yellow anomaloscopy matching range (r = -0.20742), where r denotes the correlation coefficient. Patient age was strongly correlated with Snellen results (P = 0.0001), but it was not significantly related to sex (P = 0.1187) or the presence of disciform macular degeneration in the other eye (P = 0.9989). The photostress recovery time showed enormous inter-visit variations and poor correlation with Snellen acuity (P = 0.0526). CONCLUSIONS: The course of AMD is routinely assessed by Snellen acuity and any of several additional tests. When employing a test battery in an office setting, a clinician needs to know the relative utility and correlation between the tests at his disposal. Of the tests used in this study, the Amsler grid was the most useful addition to the Snellen acuity at all stages of atrophic macular degeneration, and blue/yellow anomaloscopy was useful only in mild macular degeneration where Snellen acuity was 6/12 or better.

Aged↗
PubMed1996

Psychiatry's culture.

Culture remains an ambiguous concept for psychiatry: deprecated by the assumption that it is secondary to biomedical reality, yet at the same time some notion of 'culture' has served to represent the modern against the primitive. Contemporary clinical understandings of culture derive from imperial medicine which had applied the accepted distinction between the biological form and the cultural content of psychopathology to local illnesses which could not easily be fitted into the European nosology. The later concept of culture-bound pathology, like the psychoanalysts' 'modal personality', only imperfectly escaped from evaluative assumptions of 'development', but it is difficult to argue that psychiatry provided British colonial administrations with any significant ideological justification.

Biological Psychiatry↗
PubMed1995

The effectiveness of words: religion and healing among the Lubavitch of Stamford Hill.

Testimonials of miraculous healing offered by Lubavitch Hasidim evoke images of exile and restitution which derive from Kabbalistic texts. Mediated practically through the person of the Rebbe, these testimonials articulate both immediate affliction and ultimate meaning, physical embodiment as well as symbolic representation, each constituting the other. Both Kabbalah and medical anthropology attempt to transcend not dissimilar epistemological dualisms: those characteristic of monotheism and contemporary science. Yet the 'lower root' of Kabbalah affirms a material reality known through immediate sensory experience which recalls the rationale of biomedicine.

Anthropology↗
PubMed1995

Post-adoption incest and phenotypic matching: experience, personal meanings and biosocial implications.

Recent changes in British law have enabled adults who were adopted when young to trace their biological relatives. The reported frequency of incestuous sentiments and relationships in these reunions, together with the individual experiences and the meanings which are attached to them, challenge fundamental assumptions of both Westermarck's and Freud's theories. Post-adoption incest is characterized experientially by a romantic search for attachment followed by a recognition of oneself in the other. The question of incest has been fundamental to biosocial theories of individual and cultural development. Some revisions are proposed, principally that adult sexual interests remain constrained both by early attachments and later phenotypic matching, reinforced by personal contingencies and cultural rules.

Adolescent↗
PubMed1995

Psychopathology and personal agency: modernity, culture change and eating disorders in south Asian societies.

The cultural contribution to psychopathology may become more salient in situations of social change, but it remains difficult to distinguish individual agency among wider social and economic transitions, such as 'modernization' or simply 'culture change', which carry the potential for recourse to new patterns. Eating disorders, a biosocial pattern once identified exclusively with European societies, do occur among South Asian women including those living in the West. This seems not just a simple appropriation of contemporary Western ideals of female morphology--the 'fear of fatness'-but a reassertion of an instrumental strategy of self-renunciation in situations of experienced constraint.

Anorexia Nervosa↗
PubMed1993

Screening for congenital colour vision defects. A comparison between the Ohkuma and Ishihara plates.

A prospective comparison between the Ohkuma and Ishihara pseudoisochromatic (PIC) plates was carried out in a group of 400 patients attending a general ophthalmology practice. The sensitivity of the Ohkuma test was compared to the Ishihara test, and the specificity of both was determined by reference to anomaloscopy as a gold standard. Both tests correctly identified the same group of 24 patients as having a red/green confusion axis, and the Ohkuma test was equally as sensitive as the Ishihara. The grading plates in both tests are unreliable, but the Ohkuma test is quicker, easier to administer, gives less ambiguous responses and has a clearer cut-off score for abnormality. On the basis of this experience the Ohkuma test is recommended as more appropriate for routine colour vision screening than either the 24 or 38 plate Ishihara tests.

Adolescent↗
PubMed1992

Psychiatric diagnosis and racial bias: empirical and interpretative approaches.

Understanding of psychiatric illness among Britain's Black and ethnic minority population has shifted from an emphasis on cultural difference to one on racism within psychiatric theory and practice. In spite of this apparent turn, the explanations put forward remain within an empirical framework of methodological individualism, reflecting the background and training of British psychiatrists themselves. How racism may be actually demonstrated in individual clinical practice remains elusive. The standard hypotheses are examined here through a conventional clinical vignette study: this suggests medical education does not in itself now involve any specific racist psychiatric assumptions. Fuller understanding of the exercise of social power within this particular domain requires not only more complex interactive studies, preferably derived from a variety of clinical and social contexts, but a more developed interpretation of psychiatric practice and ideology within the social system.

Adult↗