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Biomedical subjects

S Halstead

Publications and source records attributed to S Halstead.

13 recordsLinked to original sources

Long-term outcome from a medium secure service for people with intellectual disability.

BACKGROUND: The purpose of this paper is to describe long-term outcomes for patients discharged over a 12-year period from a medium secure service for people with intellectual disabilities (ID). METHODS: A cohort study using case-notes analysis and a structured interview of current key informants. RESULTS: Eleven per cent of the sample was reconvicted. Fifty-eight per cent of the sample showed offending-like behaviour that did not lead to police contact. Twenty-eight per cent of the sample was currently detained in hospital under the Mental Health Act. The presence of a personality disorder, a history of theft or burglary, and young age increased the risk of reconviction. Contact with the police was less likely in those with schizophrenia. Re-admission to hospital was associated with the presence of offending-like behaviours, rather than any specific diagnosis. CONCLUSION: In terms of reconviction, these results are good compared with those from general forensic services; however, behavioural problems continue for many years and are managed without recourse to the criminal justice system. There is a borderline group whose needs are poorly defined and serviced. Declaration of interests Horizon National Health Service Trust, the managing authority of the service, gave the grant for this study; the corresponding author was working in the service.

Cohort Studies↗

Dengue virus type 2 in Cuba, 1997: conservation of E gene sequence in isolates obtained at different times during the epidemic.

It was recently reported that disease severity increased during the 1997 Cuban dengue 2 virus epidemic and it was suggested that this might be explained by the appearance of neutralization resistant escape mutants. We investigated these observations and ideas by sequencing 20 dengue 2 virus isolates obtained during the early (low case fatality rate) and the late (high case fatality rate) phases of the outbreak. Our results showed total conservation of the E gene sequence for these isolates suggesting that the selection of envelope gene escape mutants was not the determinant of increased disease severity. Alignment of these sequences with those available in GenBank, followed by Maximum likelihood phylogenetic analysis generated a tree, which indicated that our isolates are closely related to the virus that circulated in Venezuela in 1997/98 and subsequently in Martinique in 1998. This "American/Asian" genotype has therefore gradually dispersed across the Caribbean region during the past 5 years.

Cuba↗

Service-user and professional issues.

A review of the current literature on service-user and professional issues revealed a distinctive pattern of concerns. Whilst these mainly have an origin in the wider world of disability, they have a relevance for forensic services. Advocacy, sexuality, abuse, offending, victimology, emergency management of behaviour, law, social exclusion, models of disability and research ethics dominated the literature. There was a paucity of work on professional development or service design, although this may have been an artefact resulting from the search methodology. In the view of the present author, the striking omissions were economics, the ethics of treatment and confidentiality, and the role of society in making decisions for those who cannot make decisions for themselves. The emphasis was on the 'libertarian' disability agenda and the more 'paternalistic' concerns of forensic services were somewhat neglected.

Crime↗

Audit to improve use of central venous catheters.

Staff in one trust undertook an audit of the management of central venous catheters in the intensive care unit with the aim of measuring practice against current good practice guidelines. Specific areas of interest were infection rates, aseptic technique and training.

Catheterization, Central Venous↗

Primitive (developmental) reflexes, tardive dyskinesia and intellectual impairment in schizophrenia.

Primitive reflexes, also known as higher cerebral, developmental or release reflexes, are present in foetal and infant life, and are found in certain organic brain diseases. They are normally regarded as non-localising signs of cerebral immaturity or dysfunction which are uncommon in the normal population. The main aims of this study were to find out whether recent reports of an association between primitive reflexes and severity of cognitive impairment in dementia and between primitive reflexes and tardive dyskinesia in schizophrenia could be replicated in a younger population of schizophrenic patients. Forty-eight schizophrenic patients (mean age 51 years) were assessed for primitive reflexes, involuntary movements and cognitive function, and 58% exhibited at least one primitive reflex and 23% at least two. No association was found between primitive reflexes and cognitive impairment or between primitive reflexes and tardive dyskinesia. These results fail to support the hypothesis that the presence of primitive reflexes in some schizophrenic patients indicates a vulnerability to tardive dyskinesia and intellectual decline with advancing age, but long-term prospective studies would be required to test this hypothesis adequately. Nevertheless, these findings support the notion of neurodevelopmental or neurodegenerative brain disease in at least a proportion of patients with schizophrenia.

Adult↗

Selenium toxicosis in feeder pigs.

Selenium toxicosis was diagnosed in feeder pigs on a central Michigan farm. Use of a commercial supplement, found to contain approximately 20 times the intended Se concentration, resulted in a Se concentration of 8.1 mg/kg of the complete feed. This was fed for 34 days during which daily feed consumption decreased approximately 35%, several pigs developed weakness and forelimb paresis, and 1 pig died. The highest serum Se concentration measured was 1,550 ng/ml (normal range, 140 to 190 ng/ml). Normal feed consumption returned when an alternative feed was provided. Mean serum Se concentrations of representative pigs, monitored over the subsequent 26 days, decreased from 905 to 258 ng/ml. Histologic examination of a recovering pig revealed skeletal and cardiac myopathy and bilaterally symmetric malacia of the gray matter of the ventral horns of the spinal cord. During the developing toxicosis, the pigs consumed an estimated 11.4 mg of Se/pig/d.

Animal Feed↗

A follow-up study of Asian problem drinkers.

This is a follow-up study of 70 patients referred for treatment of drinking problems. At the end of 12 months, it was found that 60% remained in abstinence, 8.5% social drinking, 28.5% relapsed or defaulted and 3% died. A poor outcome was observed in patients between 20 and 39 years old as compared to those between 40 and 59 years old. Patients with SADQ scores of less than 20 had good outcomes. However, there was no significant difference between Indian and Chinese patients. Marital status and social class were not useful predictors of outcome.

Adult↗

Clinical economics education in the International Clinical Epidemiology Network. INCLEN Economics Faculty.

The application of rigorous epidemiologic methods to clinical questions has broadened the scope of research in epidemiology and enhanced the quality of clinical research. The International Clinical Epidemiology Network (INCLEN) has enabled physicians from developing countries to obtain training in epidemiologic methods and to provide leadership in clinical epidemiology in their home schools of medicine. The INCLEN program has recently incorporated another major theme of research training, clinical economics, which introduces research related to the effective use of limited resources. This article describes the rationale for the development of the INCLEN Clinical Economics program, outlines its organization and curriculum, and explores the challenges to its successful implementation.

Cost-Benefit Analysis↗

Psychosis associated with HIV infection.

Five cases of psychiatric illness, presenting as functional psychosis, occurring in male homosexuals with human immunodeficiency virus (HIV) infection are described and compared with similar cases in the literature. The association between psychosis and infection with HIV is discussed with particular emphasis on the significance of functional versus organic presentation.

Acquired Immunodeficiency Syndrome↗

Trypanosoma cruzi and Trypanosoma rangeli in Saimiri sciureus from Bolivia and Saguinus mistax from Brazil.

Examination of blood films for trypanosomes in primates housed at the Tulane University Delta Regional Primate Research Center showed that 47% (32/68) of the Bolivian Saimiri sciureus and 51% (68/135) of Brazilian Saguinus mistax harbored one or more types: Trypanosoma (Schizotrypanum) cruzi in 6% to 7% and Trypanosoma (Herpetosoma) spp. or Trypanosoma (Megatrypanum) spp. in 39% and 45%, respectively. Trypanosomes were isolated from a sample of the infected monkeys and morphobiological studies were carried out. Both T. cruzi and Trypanosoma rangeli were demonstrated. The transmission of T. rangeli by Rhodnius prolixus, Rhodnius neglectus, and Triatoma infestans was assessed: only R. prolixus transmitted the infection by bite. T. rangeli has not been found previously in Bolivia, nor has any trypanosome been reported previously in Saguinus mistax.

Animals↗