Analysis of treatment outcome in problem drinking.
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Alcoholism↗
Biomedical subjects
J E Wells
Publications and source records attributed to J E Wells.
Premenstrual syndrome in hysterectomized women: mood and physical symptom cyclicity.
In 36 hysterectomized women presenting with PMS, a daily record of eight mood states and five physical symptoms was kept during 109 ovarian cycles. Premenstrual tension (PMT) was estimated at a point 92% through the ovarian cycle after fitting a five-term Fourier series to the data. Although significant mood and physical-symptom swings were common (present in 71% and 69% of cycles respectively), the incidence of symptoms late in the luteal phase (PMT) was low (36%). In nine women no PMT was detected, in twenty-two women PMT was sporadic, and in five there was evidence of the consistent appearance of both mood and physical symptom-related PMT. Symptoms clustered significantly around a point 85% through the ovarian cycle for moods, and 83% for physical symptoms; this differs significantly from the 92% observed in menstruant women with PMS and is consistent with the removal of a factor associated with menstrual onset, which may contribute to the symptoms perceived by women as PMT.
Adult↗
Plasma corticotrophin releasing factor and vasopressin responses to exercise in normal man.
OBJECTIVE: To evaluate the hypothalamo-pituitary-adrenal (HPA) response to both mild and intense exercise. DESIGN: Maximum oxygen consumption (VO2max.) was initially determined. Exercise to 20% (mild) and 90% (intense) VO2max. was undertaken in random order. Subjects were exercised over a 5-minute period to the required level of intensity, which was maintained for a further 10 minutes. SUBJECTS: Six trained male athletes. MEASUREMENTS: Brachial vein blood was sampled before and at 5-minute intervals during and after exercise and assayed for plasma cortisol, ACTH, arginine vasopressin (AVP), corticotrophin releasing factor (CRF), sodium and lactate levels. Haemoglobin and haematocrit were measured before and at the end of exercise. Heart rate was monitored continuously and blood pressure measured whenever blood was sampled before and after exercise. RESULTS: Maximum heart rate was 184 +/- 2 and 82 +/- 5 (mean +/- SEM) beats per minute at 90 and 20% VO2max. respectively. Plasma volume fell by 8.7 +/- 2.4% with intense exercise. Significant increases in plasma concentrations of AVP, ACTH and cortisol, but not CRF, occurred during intense exercise. Plasma sodium concentration, which increased during intense but not mild exercise, peaked at 10 minutes after the onset of exercise and preceded the rise in plasma AVP. The AVP peak clearly preceded the ACTH peak in two subjects and occurred synchronously with it in three subjects. CONCLUSION: These results indicate that although significant HPA activation occurs during intense exercise, CRF does not appear to play a major role in mediating the ACTH response to an acute episode of vigorous exercise in man. AVP may be more important in this regard.
Adrenocorticotropic Hormone↗
Preventing alcohol problems: the implications of a case-finding study in Christchurch, New Zealand.
In 1986 the Christchurch Psychiatric Epidemiology Study obtained 1498 interviews using the Diagnostic Interview Schedule. Respondents were from a probability sample of adults aged 18-64 years. This article reports results relevant to preventing alcohol problems. The symptoms most likely ever to be experienced were types of heavy drinking (7-22%) and their consequences such as blackouts (13%). Thirty-two percent of men and 6% of women had met criteria for alcohol disorder prior to interview. The predictors of alcohol disorder were gender, childhood conduct disorder symptoms, early drunkenness, family breakdown and age of leaving school. Cohort effects were clear for onset of drunkenness and alcohol problems. The median duration of alcohol problems was at least 10 years, indicating scope for secondary prevention. General practice and hospitals appeared to be the most suitable places for intervention.
Adolescent↗
Christchurch psychiatric epidemiology study: use of mental health services.
Use of health and mental health services by the 1498 adults in the Christchurch psychiatric epidemiology study is reported. Fourteen percent of the sample had visited a health service for help with mental health problems over the preceding six months. Of those with identified psychiatric disorder during the last six months, only 29% had over that period visited a health service or professional for a mental health consultation though 75% had sought health care. Mental health consultations were more commonly with general practitioners than with mental health specialists, the latter seeing only one in seven of those with recent disorder. Those who at some point in their lives had not sought help, even though they or others had considered it necessary, reported the reasons to be attitudinal rather than to do with practical concerns such as finance, time or access to care.
Adolescent↗
Effects of age and sex on bone density at the hip and spine in a normal Caucasian New Zealand population.
We have studied a normal adult caucasian population (462 females, 264 males age range 20-84) using dual photon absorptiometry to establish patterns of bone reduction at the spine and hip. Subjects were either randomly selected from the electoral roll or volunteers. Bone mineral density reduction at the lumbar spine in females appeared to increase at 40 years and was sustained until 60 years. In males bone mineral density at the spine was preserved. The density at the hip in females decreased throughout adult life beginning before the menopause. In males bone density was preserved at the femoral neck and trochanteric region but not at Wards triangle where reduction occurred throughout life. When compared with other normal populations there was higher bone mineral density at the spine in postmenopausal New Zealand females but no significant difference at the hip.
Absorptiometry, Photon↗
Mortality in a follow up study of 616 alcoholics admitted to an inpatient alcoholism clinic 1972-76.
Six hundred and sixteen alcoholics were admitted to an inpatient alcoholism clinic (Mahu clinic, Sunnyside Hospital, Christchurch) between 1972 and 1976. The national register of deaths was searched for deaths of these patients up until 30 September 1983. Eighty-three deaths were recorded which, when compared with the general population, matched for age and sex, yielded a standardised mortality ratio of 1.6, that is 60% higher than expected. However because the patients were nearly all under 65 years of age the absolute death rate was not high--98% survived one year and 86% survived ten years. Similarly the excess death rate was quite low at 6 extra deaths per 1000 alcoholic years.
Actuarial Analysis↗
Physical symptom cyclicity in women with and without the premenstrual syndrome.
A daily record of five physical symptoms was kept by 44 women self-selected as having the premenstrual syndrome (PMS+ group, 133 menstrual cycles) and 48 women self-selected as not having PMS (PMS- group, 100 cycles). Symptoms were analysed after fitting the first five terms of a Fourier series. PMS+ women differed significantly from PMS- women in (i) the incidence of significant physical symptom swings (present in 81.2% vs 33.0% of cycles), (ii) the incidence of significant physical symptoms in the premenstruum (PMT: present in 80.5% vs 24.0% of cycles), and (iii) PMT severity (mean +/- SE, 1.37 +/- 0.08 vs 0.27 +/- 0.04). Pregnanediol excretion and the distribution of stomach cramps were similar in the two groups. The small but significant symptom increase observed in the premenstruum of PMS-women is consistent with the view that premenstrual physical symptoms, unlike premenstrual psychological symptoms, may be associated with the normal menstrual cycle. For confirmation more evidence is required.
Adult↗
Birth cohort trends in major depression: increasing rates and earlier onset in New Zealand.
In a community sample of 1498 urban adults (18-64 years) interviewed in their homes with the Diagnostic Interview Schedule (DIS), the 6-month and lifetime prevalence of major depression was higher in females than males. However, in the most recent birth cohort young men had a higher 6-month prevalence of depression. Survival analysis of the cumulative lifetime risk for major depression demonstrated a significant trend in both sexes for depression to be increasing in prevalence, and for it to be occurring at an earlier age. Thus New Zealand, like other countries, may be entering an age of melancholy.
Adolescent↗
Prevalence of three bulimia syndromes in the general population.
Prevalence of bulimia was estimated from a cross-sectional general population survey of 1498 adults, using the Diagnostic Interview Schedule (DIS) administered by trained lay interviewers. Lifetime prevalence of the DSM-III syndrome in adults aged 18-64 was 1.0% and this was concentrated in young women: in women aged 18-44 lifetime prevalence was 2.6%, and 1.0% currently had the disorder. Based on clinicians' reinterviews of random respondents and identified and marginal cases, the prevalence of current disorder using criteria for draft DSM-III-R bulimia was 0.5%, for DSM-III it was 0.2%, and for Russell's Criteria bulimia nervosa 0.0%. A strong cohort effect was found, with higher lifetime prevalence among younger women, which is consistent with a growing incidence of the disorder among young women in recent years. Although elements of the syndromes were so common as to suggest that dysfunctional attitudes to eating and disturbed behaviour surrounding eating are widespread, there was little evidence of the bulimia syndrome having become an epidemic on the scale suggested by early reports.
Adolescent↗
Anaesthesia and outcome of surgery for fractured neck of femur.
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Aged↗
The epidemiology of thyrotoxicosis in New Zealand: incidence and geographical distribution in north Canterbury, 1983-1985.
In a 3-year (1983-1985) epidemiological study of thyrotoxicosis in North Canterbury, New Zealand, the annual incidence was 25.8 per 100,000 (female 40.7, male 10.5). Thyroid scintiscanning showed that 64% had diffuse hyperplasia (DH), 27% toxic multinodular goitre (TMG), 7% toxic uninodular goitre (TUG), and 2% zero uptake. The calculated annual incidence of toxic diffuse goitre (DH) was 15 per 100,000, and for toxic nodular goitre (TMG and TUG combined) was 8 per 100,000. The age-related incidence for toxic diffuse goitre peaked in middle life whereas toxic nodular goitre showed an increasing incidence with age. There was no significant seasonal variation or rural/urban difference in incidence. Analysis of geocoded addresses did not identify areas of high incidence. The variable duration of symptoms prior to diagnosis limits the search for possible environmental trigger factors. North Canterbury was an endemic goitre area prior to the introduction of iodized salt 50 years ago, and the incidence of toxic nodular goitre is likely to fall in future.
Adolescent↗
Cartier loop biopsy of the cervix: a retrospective study of 6 months' experience with a one-year follow-up.
Ninety-six women with cervical pathology underwent Cartier loop biopsy at Christchurch Women's Hospital, during the first 6 months of 1987. Eighty-four (88%) patients had full follow-up past 11 months, of whom 10 (12%) had dysplasia/CIN. Initial follow-up (3-8 months) was achieved in 91 (95%) patients, of whom 11 (12%) had dysplasia/CIN. Follow-up was predominantly by cytology. These rates were not significantly influenced by any single preoperative or operative factor. The implications of these results are discussed.
Adolescent↗
Factors affecting the use of mental health services in people with alcohol disorders.
In a preliminary analysis of data from a community survey of psychiatric disorders in urban Christchurch, 157 of the 1018 adults interviewed met diagnostic criteria for alcohol abuse and/or dependence. The subjects who met the criteria for alcohol abuse and/or dependence were more likely to have used mental health services than the population at large, although 39% of those with an alcohol disorder had never used any form of mental health service. We examined the impact of severity of alcohol disorder, duration of disorder and gender on the use of services among those with an alcohol disorder. Duration of disorder was not related to use of mental health services. Women are more likely than men to use these services. However, the most important finding was that those with the most severe disorders were most likely to have used mental health services.
Adult↗
Mood cyclicity in women with an without the premenstrual syndrome.
A daily record of seven mood states was kept (a) by 44 women self-selected as having the premenstrual syndrome (PMS+ group, 133 menstrual cycles) and (b) by 48 women self-selected as not having PMS (PMS- group, 100 cycles). Mood patterns were analysed after fitting the data to a 5-term Fourier series. PMS+ women differed significantly from PMS- women in (i) the self-rating of PMS at interview (62.1 +/- 2.8 (SE) vs 8.8 +/- 1.2), (ii) the incidence of significant mood swings (present in 76.7 vs 54.0% of cycles, (iii) the incidence of premenstrual tension (PMT present in 69.9% vs 8.0% of cycles), (iv) the score for PMT severity (96.0 +/- 12.6 vs 4.1 +/- 5.2), (v) the background mood score (31.6 +/- 10.0 vs 23.6 +/- 12.0). It is concluded that significant mood changes occur both in women with PMS and in women without PMS, but that the changes are larger and the dysphoria concentrated in the premenstrual period in the PMS+ group. In PMS- women dysphoria occurred sporadically and was not confined to the premenstruum.
Adult↗
Assessment of the significance and severity of premenstrual tension--I. A new model.
A method is proposed for analysing daily mood scores for premenstrual tension (PMT) in single menstrual cycles by fitting an approximation function consisting of the first two harmonics of a Fourier series. On the basis of harmonic analysis of 133 cycles of daily mood scores obtained from women perceiving themselves to have the premenstrual syndrome (PMS), the severity of PMT is taken to be the difference between the mean and the fitted function at a point 92% of the way through the menstrual cycle. The significance of the severity is calculated statistically. Significant PMT was detected in 70% of the 133 cycles; this compared with an 8% incidence in women who considered that they did not have PMS. The method improves on previously described methods for detecting PMT by: (1) using statistical criteria; (2) modelling cycles with asymmetric and double peaks; (3) using a difference rather than a ratio as the severity estimate; (4) smoothing the data and (5) giving valid estimates when data points are missing. There was no evidence for the presence of distinct periodicities with wavelengths less than half that of the menstrual cycle.
Adolescent↗
Assessment of the significance and severity of premenstrual tension--II. Comparison of methods.
Seven methods for the detection of premenstrual tension (PMT) have been compared, using daily records of bipolar mood scores kept by 44 women with the premenstrual syndrome during 133 menstrual cycles. Four of the methods were simple procedures based on contrasting the premenstrual scores with those elsewhere in the cycle and using either a ratio or difference to detect PMT. In the other three methods, the mood scores were fitted to a model. The comparison suggest that methods which (1) use bipolar scores, (2) optimise the thresholds separating PMT+ from PMT- cycles and (3) are based on known PMT symptom patterns, are likely to be satisfactory whatever their level of sophistication. Methods based on unipolar scores on the other hand, succeed only when PMT severity is measured as the difference between two quantities, and fail when ratios are used. In this study with its bipolar mood score data base, six of the methods gave similar results. Discrepancies between methods (9-23%) were associated with double symptom peaks and with the appearance of symptoms early in the luteal phase. For such cycles only the method based on a 5-term Fourier series provided useful information.
Emotions↗
Deep vein thrombosis after total hip replacement. A comparison between spinal and general anaesthesia.
The effect of hypobaric spinal anaesthesia or narcotic-halothane-relaxant general anaesthesia on the incidence of postoperative deep vein thrombosis was studied in 140 elective total hip replacements in a prospective randomised manner. Deep vein thrombosis was diagnosed using impedance plethysmography and the 125I fibrinogen uptake test, combined, in selected cases, with ascending contrast venography. The overall incidence of deep vein thrombosis was 20%. Nine patients (13%) developed deep vein thrombosis in the spinal group and nineteen (27%) in the general anaesthetic group (p less than 0.05). The incidences of proximal thrombosis and of bilateral thrombi were also less with spinal anaesthesia than with general anaesthesia. It is concluded that spinal anaesthesia reduces the risks of postoperative thromboembolism in hip replacement surgery. The presence of varicose veins, being a non-smoker and having a low body mass index were associated with an increased incidence of deep vein thrombosis.
Aged↗