Brief report: a double-blind study of naltrexone in infantile autism.
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Adolescent↗
Biomedical subjects
D Waller
Publications and source records attributed to D Waller.
Neuropsychological function in young children who have undergone liver transplantation.
Presented neuropsychological data from 20 patients between the ages of 4 and 9 years, who had undergone liver transplantation at least 12 months prior to study participation, and compared them to a control group of 20 children with cystic fibrosis. The liver transplant group showed deficits in VIQ, PIQ, visual-spatial and abstraction/reasoning skills, but not in alertness/concentration, motor, or sensory-perceptual functions. On motor and sensory-perceptual tests, no differences were found in direction of lateralization of deficits. Visual-spatial deficits found in this study sample are similar to those found in adults with end-stage liver disease and in a previous report of an overall older group of children following liver transplantation. However younger children have greater evidence of generalized impairment and VIQ deficits which have not been found in older groups. Findings are discussed in relation to possible etiology, location of brain damage, and clinical implications.
Brain Damage, Chronic↗
[Major methodologic shortcomings in the article on the treatment of alcoholism].
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Alcohol Drinking↗
Health checks in general practice: another example of inverse care?
OBJECTIVE: To assess attendance at and the characteristics of patients attending health checks for cardiovascular disease offered in a general practice over a period of five years (1984-9). DESIGN: Medical record audit and postal questionnaire survey. SETTING: One general practice in Oxfordshire with a socially diverse population. PARTICIPANTS: 1101 Men and 1110 women aged 35-64 registered with the practice. MAIN OUTCOME MEASURES: Age, sex, marital state, social class, smoking habits, alcohol consumption, and diet. RESULTS: Of the 2211 men and women in the target age group (35-64) in 1989, 1458 (65.9%) had been offered screening and 963 (43.6%) had attended for a health check. Attenders were more likely to be women, aged greater than or equal to 45, married, non-smokers, and of higher social class than patients who did not respond to the invitation. The relative likelihood of non-attendance was 1.24 for smokers, 1.20 for the overweight, 1.16 for heavy drinkers, and 1.28 for those with a less healthy diet, even after adjustment for age, sex, marital state, and social class. CONCLUSIONS: After five years of offering health checks, opportunistically (to men) and in the context of cervical smear tests (to women), less than half of the eligible patients had attended. The likelihood of acceptance of an invitation to attend was inversely related to the patient's cardiovascular risk for all factors measured except age. A coherent strategy to reduce cardiovascular disease depends on more careful targeting of scarce health service resources and more emphasis on public health measures (such as dietary regulation and tobacco taxation). Doctors should be careful not to absolve the government of its public health obligations by substituting unproved preventive interventions aimed at the individual patient.
Adult↗
Open comparison of intramuscular chloroquine and quinine in children with severe chloroquine-sensitive falciparum malaria.
An open paired randomised comparison of intramuscular chloroquine (3.5 mg base/kg every 6 h) and intramuscular quinine (20 mg salt/kg followed by 10 mg/kg every 12 h) was carried out in 50 Gambian children with severe falciparum malaria. 8 children died, 6 from the quinine-treated and 2 from the chloroquine-treated group. Chloroquine reduced parasitaemia significantly more rapidly than did quinine, but other measures of the therapeutic response were similar in the two groups. Quinine injections were painful. These findings do not support the proposition that quinine is intrinsically superior to chloroquine in the treatment of severe drug-sensitive falciparum malaria.
Administration, Oral↗
Antidepressant drugs: additional clinical uses.
Three decades of psychiatric practice with tricyclic, tetracyclic, and heterocyclic antidepressants have shown that these drugs are effective not only for major depression, endogenous depression in particular, but also for a range of other disorders. Tricyclic and other antidepressants are now used to treat enuresis and attention-deficit disorders in children, bulimia and anorexia nervosa, panic disorder, posttraumatic stress disorder, obsessive-compulsive disorder, chronic pain, migraine, and peptic ulcer disease. As with some of the antidepressants, the body of literature on the relationship between clinical response in these diseases and plasma or serum levels of the drugs is not complete or well understood, but for some of these disorders, sufficient preliminary serum level data are available to take advantage of therapeutic drug monitoring as an adjunct to treatment. Therapeutic monitoring can be particularly important where studies indicate that successful therapy occurs at blood levels substantially different from those used to treat depression. This paper presents a brief overview of antidepressant treatment of these disorders, focusing on the available pharmacologic data related to serum level measurements and their relation to clinical response.
Antidepressive Agents↗
Emotional coping and the psychophysiological substrates of elevated blood pressure.
A structured interview concerning emotional coping patterns was administered to 63 28-year-old men included in a psychophysiological study of blood pressure elevation. The interviews were tape recorded and subsequently evaluated by a rater not otherwise involved in the study. The interviews involved discussion of four emotions: anger, sorrow, anxiety, and joy. The results indicate that normotensives can express sorrow to significantly more people than hypertensives, and that their behavior in situations involving sorrow tends to be more instrumental than that of the group with labile pressure. Hypertensives also experienced significantly less joy than normotensives. In multiple regression analyses on physiological variables relevant for blood pressure elevation, the use of a somatic and unfocused way of describing sorrow was associated with significantly lower heart rate. The results show also that emotional coping explains a significant amount of the variance in three of the psychosocial functions involved in elevated blood pressure: ability to express anger at work, plus the social support variables of attachment and acquaintance.
Adaptation, Psychological↗
Young men with high blood pressure report few recent life events.
Men who had high, medium and low blood pressure at age 18 (compulsory screening for military service in Stockholm) were examined ten years later at age 28. Interviewers, having had no information regarding past or present blood pressure, interviewed them about life events experienced during the year preceding the examination. Men with high blood pressure at rest reported fewer life events for the past year than other men. Furthermore, high plasma adrenaline levels at rest were associated with few reported life events.
Adolescent↗
[Hypertension in young people in relation to psychosocial factors].
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Adolescent↗
The relation of social support and working environment to medical variables associated with elevated blood pressure in young males: a structural model.
The object of the present study was to examine the interaction of working environment factors and the individual social support network with medical variables related to blood pressure elevations in young (mean age = 28 years) hypertensives. The results of path analyses reveal that the medical variables which explained a significant amount of the variation in systolic blood pressure were blood hemoglobin, plasma adrenaline and relative weight. High relative weight was associated with a low level of employment security and high plasma adrenaline with a poor self-reported social network as well as a job providing few possibilities for learning new things. High levels of diastolic pressure were associated with elevated hemoglobin levels, increased heart rate and low plasma renin activity. Increased heart rate was influenced by a lack of 'anger' coping in conflict situations at work and a low number of contacts with acquaintances. Working environment and social support are hypothesized to assert their influence through increased sympathetic stimulation mediated by limbic-hypothalamic discharge.
Adaptation, Psychological↗
Blood pressure variations during a working day at age 28: effects of different types of work and blood pressure level at age 18.
During an ordinary work day blood pressure was self-monitored once every hour in two samples of asymptomatic nonmedicating 28-year-old men. They were selected on the basis of previous compulsory blood pressure recordings made at the age of 18 when they had been drafted for military service. Subjects in the "original hypertensive sample" with "strain" occupations (hectic and uncontrollable, such as waiter, driver and cook) had more marked elevations of systolic blood pressure during work hours than other subjects.
Adult↗
Psychosocial and physiological factors in relation to blood pressure at rest--a study of Swedish men in their upper twenties.
The interrelationships between psychosocial factors, several physiological variables and blood pressure (BP) were investigated in 88 young men (aged 26-32 years) in whom high, intermediate or low BP had been recorded at the age of 18 years. In the original high BP group, venous plasma noradrenaline was normal but adrenaline levels elevated. At the follow-up adrenaline correlated with systolic blood pressure (SBP), and this was also so after controlling for overweight and serum gamma-glutamyltranspeptidase [gamma-GT, a marker for alcohol consumption, which showed an independent association with diastolic blood pressure (DBP)]. Low assertiveness (low scores of verbal and indirect aggression) correlated with high BPs, even after controlling for other psychosocial variables. Several associations between psychosocial job variables and physiological variables were found. Among self-reported job variables, excessive 'demands' and 'bossing others' (but not 'decision latitude' or 'psychosocial conflict') were associated with high SBP. Habitual smoking of cigarettes was not associated with BP at rest, but influenced several associations between psychosocial and physiological variables. Men with high BP at rest and low plasma renin activity (PRA) reported more psychosocial problems at work and lower assertiveness than other groups.
Adult↗
An evaluation of six solid-phase thyrotropin (TSH) kits.
This article describes an objective evaluation of six thyrotropin (TSH) kits. One was a radioimmunoassay kit taken for comparison, three were immunoradiometric assays and one was an immunoenzymometric assay. The laboratory internal immunoluminometric assay for thyrotropin was used to measure the concentrations of thyrotropin in the kit standards using a standard curve of WHO 68/38 international reference preparation in serum from a thyrotoxic patient as matrix. The in-house assay was used to demonstrate the "sensitivity" to citrated plasma and the fact that kit standards could only measure "correctly" when used in its own kit. The study was carried out in a "blind" way, the assayist and organiser not knowing from which of the four groups under test (blood donors - serum and citrated plasma, thyroliberin-test and thyroid outpatient clinic patients) the samples came until the study had been completed. The immunometric assay kits were able to differentiate statistically between euthyroid and untreated hyperthyroid patients, although one IRMA kit (Kit F) had a large "grey zone" where both euthyroid and hyperthyroid patients overlapped. Compound precision profiles covering the range 0-5 mU/l thyrotropin were good, a mean coefficient of variation under 5% within the range 0.5-5 mU/l being demonstrated by 3 immunometric assays. The immunometric assay kit with the most cumbersome methodology showed, as was to be expected, the worst precision. The euthyroid ranges for thyrotropin were similar in 3 immunometric assay kits using the WHO 68/38 reference material as calibrator (Kits C and E, 0.25-3 mU/l) and correlated well with one kit using the 2nd IRP (NIBSC 80/558) as calibration material (Kit D 0.33-4 mU/l), although the results were around 30% higher in Kit D. The second kit (Kit A) using the 2nd IRP material as calibrator gave identical values with the kits using the WHO 68/38 reference thyrotropin-preparation for calibration purposes. In a further kit (Kit F) it was stated that both thyrotropin international reference preparations gave rise to identical serum values when used as calibrators. The thyroliberin-test may have an additional role to play in monitoring returning pituitary function in thyrotoxic patients under treatment as the immunometric assay kits were easily able to measure a thyrotropin difference of 0.5 mU/l in the range 0-1 mU/l. The conventional radioimmunoassay (Kit B) was unable to match the precision and sensitivity of the better immunometric assay kits in the range under 1 mU/1.(ABSTRACT TRUNCATED AT 400 WORDS)
Evaluation Studies as Topic↗
Brachial neuritis in salmonellosis.
A case of bilateral brachial plexus neuritis associated with a salmonella infection is reported. The three types of nerve involvement in salmonellosis, mononeuritis, brachial plexus neuritis and polyradiculoneuritis are described. Prognosis and pathogenesis are discussed.
Adolescent↗
Hypoglycaemia due to azapropazone-tolbutamide interaction.
We report a case of hypoglycaemia due to a 'first-dose' interaction between azapropazone and tolbutamide. The mechanism was probably by displacement of tolbutamide from protein binding sites, and it is recommended that azapropazone should be avoided in patients receiving tolbutamide.
Apazone↗
Smoking and pain--a method of limits and sensory decision theory analysis.
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Adolescent↗
On the interplay between socioeconomic factors, personality and work environment in the pathogenesis of cardiovascular disease.
This article summarizes some of the major findings in research on associations between psychosocial factors and cardiovascular illness. Methodological difficulties are discussed. Findings from some of the authors' own studies serve as illustrations. It is emphasized that an interplay between environmental and individual factors is of great importance. Personality factors relevant to the risk of cardiovascular illness may distort individual descriptions of the work environment. Cardiovascular risk factors such as cigarette smoking and repeated blood pressure elevations may be influenced by psychosocial factors. Lack of intellectual discretion at work, particularly if combined with excessive demands, may increase the risk of cardiovascular illness.
Adult↗
Smoking, pain tolerance, and physiological activation.
The effects of tobacco smoking and beta-blockade on psychophysiological measures, i.e., heart rate (HR), blood pressure (BP), skin conductance (SC), and sensitivity to electrical pain stimulation was studied in a group of 33 male moderate smokers. Using a method of limits threshold determination technique, measures of pain threshold (PT), and tolerance level (TL) were obtained. The results were analyzed in relation to smoking habits, personality measures, and subjective effects. There was no significant effect of smoking on pain sensitivity. Smoking caused a physiological activation as indicated by an increase in HR and systolic BP. beta-Blockade counteracted the smoking-induced increase in HR and systolic BP, but did not influence PT or TL. Subjective effects of smoking were not affected by beta-blockade. The findings suggest that physiological activation is not related to effects of smoking on pain.
Adrenergic beta-Antagonists↗