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Biomedical subjects

H Ashton

Publications and source records attributed to H Ashton.

At least 19 recordsLinked to original sources
PubMed1997

Patterns of alcohol consumption, smoking and illicit drug use in British university students: interfaculty comparisons.

The use of tobacco, alcohol and illicit drugs was investigated by questionnaire in 3699 second year students in ten UK universities. Patterns of use varied considerably between different faculty groups. Tobacco use was most prevalent in arts, social science and biological science students, among whom 36-39% of men and nearly one third of women were regular smokers, and least in female veterinary students (5%). Alcohol consumption was greatest in biological science students: 23% of those who drank exceeded 'hazardous' levels compared with 10-16% in all other faculties. Prevalence of cannabis use was highest in arts and social science students of whom 27% reported regular weekly use compared with 9-22% in other faculties. Experience with other illicit drugs was greatest among arts, social science and physical science students, of whom 64-71% reported experience at least once or twice, and least among veterinary students (42%). Identification of different lifestyles may help to direct appropriate health information to particular student groups.

Alcohol Drinking↗
PubMed1995

Pharmacokinetic and pharmacodynamic responses to caffeine in poor and normal sleepers.

Pharmacokinetic and pharmacodynamic responses to caffeine (2.5 mg/kg) were compared between ten healthy self-rated poor sleepers and ten normal sleepers. Sleep pattern assessed by the Pittsburgh Sleep Quality Index (PSQI). There was no significant difference in mean estimated daily caffeine consumption between the groups. The poor sleepers had significantly higher scores for neuroticism on the Eysenck Personality Questionnaire (EPQ) and anxiety on the Hospital Anxiety Depression (HAD) scale, compared with normal sleepers. Caffeine pharmacokinetics were assessed by measurement of saliva caffeine concentrations. Poor sleepers showed significantly greater variability in caffeine Cmax, clearance had half-life, compared to normal sleepers. Pharmacodynamic measures included heart rate, blood pressure, visual analogue scales for concentration, vigilance and relaxation, psychomotor performance [Digit Symbol Substitution Test (DSST) and tapping rate (TR)] and EEG activity [Contingent negative variation (CNV), auditory evoked potential and power spectral analysis]. Prior to caffeine administration, poor sleepers compared to normal sleepers had faster heart rates, lower ratings for concentration and relaxation, poorer performance on the DSST, greater CNV magnitude, faster peak alpha frequency and lower delta, theta and beta power. These differences persisted after caffeine ingestion and overall differences between the groups on these measures were significant (P < 0.01-.001). Post-dose, but not pre-dose, scores for vigilance and TR were significantly lower overall in poor compared with normal sleepers. Despite the baseline differences between poor and normal sleepers, the changes following caffeine administration were similar in direction and magnitude in both groups.

Adult↗
PubMed1995

Private costs associated with abdominal aortic aneurysm screening: the importance of private travel and time costs.

OBJECTIVES: To assess the importance of the private costs incurred by patients when making a judgment on the economics of screening for abdominal aortic aneurysm (AAA), and to explore the variation in such costs depending on screening location. SETTING: A district general hospital and general practitioner surgeries. METHODS: Four hundred and ninety nine consecutive subjects attending for AAA screening completed a questionnaire asking about travel arrangements for the journey to and from the clinic, the distance travelled, the time taken, the mode of transport, and any out-of-pocket expenses incurred. In addition, at the clinic each subject was asked what activities they had forgone in attending the clinic. Time was valued differently depending on whether work or leisure activities were forgone. The total private cost for each attender was calculated and comparison was made between attenders at hospital and at general practice. RESULTS: A significantly greater proportion of subjects were accompanied when attending hospital than when attending general practitioner (GP) surgeries. Most attenders travelled by car, but the journey time was significantly longer for those visiting hospital. The expected total private cost associated with attendance for AAA screening was 5.47 pounds. Attendance at GP surgeries had a lower private cost (4.21 pounds) than attendance at hospital (6.87 pounds). Only 7.3% of all men surveyed, and 6.5% of all companions, would have been taking part in some form of paid occupation if they had not attended for screening. CONCLUSION: Despite the fact that most attenders for AAA screening will be retired, the associated private costs are appreciable and should be considered in assessing the economics of such screening programmes. The level of private costs varied depending on the location of screening; clinics held at GP practices had lower private costs than those held at hospital.

Aged↗
PubMed1994

An exploratory study of students' perceptions of the benefits of regular small group tutorials in a 2-year day release course.

This study was undertaken with the intention of improving the effectiveness of small group tutorials in a diploma in nursing course. There was concern to avoid some of the less valuable aspects of tutorials highlighted in the literature. An investigation was conducted to elicit students' perceptions of the benefits of group tutorials at a comparatively early stage in their 2-year course, at the end of the second term. A qualitative approach was taken to explore the views of four students through individual semi-structured interviews. Additional data were gathered through personal field notes to add the tutor's perspective of the group process. Data were analysed inductively using a phenomenological approach in an attempt to elucidate the essence of each participant's experience of the tutorials. While the findings suggested that students valued their involvement in small group tutorials, some questions were raised which point to the need for further investigation. Themes were revealed which drew attention to the value students place on the experience of small group tutorials, thus endorsing the strategies employed. Benefits to students include the opportunity to get to know a small group of people when part of a larger learning group, support when coping with the pressures of course work and being able to share ideas about issues relevant to nursing. The report concludes that there is scope for further investigation and reflection in order to develop educational practice.

Adaptation, Psychological↗
PubMed1994

The treatment of benzodiazepine dependence.

Withdrawal of benzodiazepines is currently advised for long-term benzodiazepine users because of doubts about continued efficacy, risks of adverse effects, including dependence and neuropsychological impairment and socio-economic costs. About half a million people in the UK may need advice on withdrawal. Successful withdrawal strategies should combine gradual dosage reduction and psychological support. The benzodiazepine dosage should be tapered at an individually titrated rate which should usually be under the patient's control. The whole process may take weeks or months. Withdrawal from diazepam is convenient because of available dosage strengths, but can be carried out directly from other benzodiazepine. Adjuvant medication may occasionally be required (antidepressants, propranolol) but no drugs have been proved to be of general utility in alleviating withdrawal-related symptoms. Psychological support should be available both during dosage reduction and for some months after cessation of drug use. Such support should include the provision of information about benzodiazepines, general encouragement, and measures to reduce anxiety and promote the learning of non-pharmacological ways of coping with stress. For many patients the degree of support required is minimal; a minority may need counselling or formal psychological therapy. Unwilling patients should not be forced to withdraw. With these methods, success rates of withdrawal are high and are unaffected by duration of usage, dosage or type of benzodiazepine, rate of withdrawal, symptom severity, psychiatric history or personality disorder. Longer-term outcome is less clear; a considerable proportion of patients may temporarily take benzodiazepines again and some need other psychotropic medication. However, the outcome may be improved by careful pharmacological and psychological handling of withdrawal and post-withdrawal phases.

Anti-Anxiety Agents↗
PubMed1994

Is screening once at age 65 an effective method for detection of abdominal aortic aneurysms?

OBJECTIVE: To evaluate whether a single screening at 65 or screening at 65 and 70 are the methods of choice to detect the majority of abdominal aortic aneurysms (AAA) suitable for treatment. SETTING: District general hospital, district general practice and community. METHODS: Data were collated from four studies (a pilot, a control trial, and two cohorts) of abdominal ultrasound screening of an invited group of 11 666 men and women aged 65-80 to derive age related prevalence, invitation acceptance rates, and operative mortality. Deaths from AAA rupture were obtained from district registrars' returns. RESULTS: The prevalence of AAA increased with age being greater overall in men (6.8%) than in women (1.2%). From ages 65 to 80 the prevalence in men increased from 5.4% to 10.4%, and in women from 0.6% to 2.1%. In men and women 4% of patients dying from AAA rupture were aged 65 or under and 85% of deaths occurred over the age of 70. Acceptance rates for screening decreased between 65 and 80 from 80.5% to 66.2% in men and from 72.7% to 58.3% in women. In elective or symptomatic patients operative mortality was zero up to the age of 70, increasing to 7.1% in older patients. CONCLUSIONS: Men should be screened at age 65 to obtain a high acceptance rate and to identify those with AAA most likely to benefit from treatment. The prevalence is relatively low at this age so an additional screen at age 70 is recommended, which would pick up a further 3.7% of patients with AAA, at which age intervention is likely to be of benefit.

Age Factors↗
PubMed1994

Guidelines for the rational use of benzodiazepines. When and what to use.

The main actions of benzodiazepines (hypnotic, anxiolytic, anticonvulsant, myorelaxant and amnesic) confer a therapeutic value in a wide range of conditions. Rational use requires consideration of the large differences in potency and elimination rates between different benzodiazepines, as well as the requirements of individual patients. As hypnotics, benzodiazepines are mainly indicated for transient or short term insomnia, for which prescriptions should if possible be limited to a few days, occasional or intermittent use, or courses not exceeding 2 weeks. Temazepam, loprazolam and lormetazepam, which have a medium duration of action are suitable. Diazepam is also effective in single or intermittent dosage. Potent, short-acting benzodiazepines such as triazolam appear to carry greater risks of adverse effects. As anxiolytics, benzodiazepines should generally be used in conjunction with other measures (psychological treatments, antidepressants, other drugs) although such measures have a slower onset of action. Indications for benzodiazepines include acute stress reactions, episodic anxiety, fluctuations in generalised anxiety, and as initial treatment for severe panic and agoraphobia. Diazepam is usually the drug of choice, given in single doses, very short (1 to 7 days) or short (2 to 4 weeks) courses, and only rarely for longer term treatment. Alprazolam has been widely used, particularly in the US, but is not recommended in the UK, especially for long term use. Benzodiazepines also have uses in epilepsy (diazepam, clonazepam, clobazam), anaesthesia (midazolam), some motor disorders and occasionally in acute psychoses. The major clinical advantages of benzodiazepines are high efficacy, rapid onset of action and low toxicity. Adverse effects include psychomotor impairment, especially in the elderly, and occasionally paradoxical excitement. With long term use, tolerance, dependence and withdrawal effects can become major disadvantages. Unwanted effects can largely be prevented by keeping dosages minimal and courses short (ideally 4 weeks maximum), and by careful patient selection. Long term prescription is occasionally required for certain patients.

Aged↗
PubMed1991

Protracted withdrawal syndromes from benzodiazepines.

The benzodiazepine withdrawal syndrome is a complex phenomenon which presents serious difficulties in definition and measurement. It is particularly difficult to set out precise limits on its duration. Many withdrawal symptoms are a result of pharmacodynamic tolerance to benzodiazepines, some mechanisms for which are discussed. Such tolerance develops unevenly in different brain systems and may be slow to reverse. Withdrawal symptoms occurring in the first week after cessation of drug use tend to merge with more persistent symptoms that may last for many months. These prolonged symptoms do not necessarily constitute "true" pharmacological withdrawal symptoms, but are nevertheless related to long-term benzodiazepine use. Such symptoms can include anxiety, which may partly result from a learning deficit imposed by the drugs, and a variety of sensory and motor neurological symptoms. The protracted nature of some of these symptoms raises the possibility that benzodiazepines can give rise not only to slowly reversible functional changes in the central nervous system, but may also occasionally cause structural neuronal damage.

Aged↗
PubMed1991

Psychotropic-drug prescribing for women.

The reasons for women in Europe and North America being prescribed over twice as many psychotropic drugs as men are complex. Psychiatric disorders such as depression and anxiety appear to be more common in women than in men, and women more commonly complain of psychological symptoms. There may be a gender bias in medical diagnosis and choice of medication. Sociological factors may also be involved, including the likelihood that women have fewer outlets than men for symptom control by activities outside the home (e.g. the social use of alcohol). Women also have special problems including pregnancy, lactation, child rearing and pre-menstrual tension. Probably, much use of psychotropic-drug use for women (and men) is inappropriate and not closely related to the symptoms or conditions for which they are prescribed. Furthermore, the chronic use of some psychotropic drugs, especially benzodiazepines, may compound the problem by inducing dependence and withdrawal symptoms.

Drug Prescriptions↗
PubMed1989

Tranquillisers: prevalence, predictors and possible consequences. Data from a large United Kingdom survey.

Data related to tranquilliser/hypnotic use is presented from a large (n = 9,003) random representative United Kingdom sample of adults (18+ years). On the day of interview 4.2% of females and 2.1% of males reported current use of tranquillisers. Increased probability of current use was significantly related to female sex, older age, increased symptoms of psychological malaise and physical ill-health, elevated neuroticism scores on the Eysenck Personality Inventory, lower socioeconomic status, unemployment, current smoking in some groups, and less participation in active leisure pursuits. There was no convincing trend with standard geographical region.

Adult↗
PubMed1988

Cortical evoked potentials and clinical rating scales as measures of depressive illness.

Relationships between clinical ratings and cortical evoked potentials were examined before and during antidepressant drug treatment in 32 patients with major depressive disorder (DSM-III). Clinical rating scales included Hamilton Rating Scale for Depression, Beck Depression Inventory, Present State Examination (PSE) and Newcastle Scale. Evoked potentials included contingent negative variation (CNV), post-imperative negative variation (PINV) and auditory evoked potential (AEP) There were close correlations between all rating scales, and factor analysis produced only one component, suggesting that the common variance between them related to severity of depression. CNV magnitude before treatment correlated negatively with severity of depression regardless of diagnostic category. Depressed patients had a prominent PINV which persisted during antidepressant treatment. The amplitude of late components (N1P2) of the AEP was reduced strikingly in patients with a history of suicide attempts.

Adult↗
PubMed1986

Transcutaneous electrical nerve stimulation produces variable changes in somatosensory evoked potentials, sensory perception and pain threshold: clinical implications for pain relief.

Transcutaneous electrical nerve stimulation decreased early and late somatosensory evoked potential amplitudes and stimulus intensity ratings, and elevated sensory detection threshold, in normal subjects. Effects on pain threshold depended on pre-treatment threshold. These findings are relevant to treatment of clinical pain by transcutaneous electrical nerve stimulation.

Adult↗
PubMed1984

Effects of acupuncture and transcutaneous electrical nerve stimulation on cold-induced pain in normal subjects.

The effects of acupuncture, transcutaneous electrical nerve stimulation (TENS) at high (100 Hz) and low (8 Hz) frequency and placebo on pain induced by cold immersion of the hand were studied in 46 young healthy male and female volunteers. Acupuncture produced significant elevations of pain threshold, while 100 Hz TENS or placebo had no effect. Eight Hertz TENS produced elevation of pain threshold with significant variation in response between individuals. There was some evidence that the L scale score of the Eysenck Personality Questionnaire predicted analgesic outcome for 8 Hz TENS. No significant relationship was found between baseline pain threshold or tolerance and personality variables.

Acupuncture Therapy↗