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Biomedical subjects

John A Cunningham

Publications and source records attributed to John A Cunningham.

32 records · Page 2Linked to original sources
PubMed2005

Innovative approaches to intervention for problem drinking.

PURPOSE OF REVIEW: To critique the recent literature on telephone, correspondence-based, and computerized interventions for alcohol problems, which enhance or substitute for practitioner-delivered treatments. RECENT FINDINGS: There is an unmet need for screening, assessment and intervention for alcohol problems, in part because of the difficulty in accessing such treatment within the current health care system. Research on the efficacy of correspondence or electronic (for example Internet-based) interventions is beginning to emerge. In the period 2003-2004 we identified nine acceptability or feasibility studies of these approaches and seven efficacy trials covering a wide range of settings. These modes of intervention are acceptable to patients and the public, and with careful planning, can be implemented in a variety of settings. Treatment trials demonstrate the efficacy of these interventions in reducing hazardous drinking by university students, in delaying initiation of heavy drinking in children and adolescents, and, intriguingly, in addressing insomnia among recovering alcoholics. SUMMARY: There is strong support among potential users for alcohol interventions that employ telephone assistance, written correspondence, and the Internet. These new technologies offer the prospect of increasing the reach of interventions for problem drinking and being cost-effective alternatives or supplements to face-to-face health service delivery.

Journal Article↗
PubMed2004

Using collaterals to validate self-reports of problem drinkers: any impact on client attrition and quantity of drinking reported?

OBJECTIVE: To explore the impact of asking for a collateral on respondent attrition and the impact of providing versus not providing a collateral on self-reported drinking. METHOD: As part of a larger trial assessing the efficacy of self-help materials for problem drinkers, respondents were randomly assigned to be asked or not asked to provide a collateral at the time of their 6-month follow-up. RESULTS: While there was no significant impact of client attrition, respondents who were asked for a collateral and provided one reported higher levels of alcohol consumption at the 6-month follow-up as compared to those who were asked for a collateral but did not provide one. CONCLUSIONS: Providing a collateral may have an impact on respondent's self-reported drinking. Alternate explanations for this finding are discussed.

Adult↗
PubMed2004

Only one in three people with alcohol abuse or dependence ever seek treatment.

The proportion of respondents who had a lifetime diagnosis of alcohol abuse or dependence who ever attended addiction treatment was determined using data from a Canadian population survey. Only one in three of these respondents had ever attended treatment for their alcohol concerns. Respondents' age and severity of alcohol problem (alcohol abuse versus dependence) were significantly associated with addiction treatment attendance.

Adult↗
PubMed2003

Interest in self-help materials among a general population sample of smokers.

Previous studies have shown that self-help materials can be effective in helping people quit smoking. However, it is not known what proportion of smokers in the general population are interested in this method of cessation. A representative sample of 267 daily smokers participated in a random digit dialing telephone survey. Respondents were asked about their level of interest in self-help materials that would help them quit smoking. Potential predictors of level of interest were examined first through bivariate analyses, followed by a multinomial logistic regression. Of daily smokers, 27% were very interested in receiving a self-help booklet, 28% were somewhat interested, and 45% were not at all interested. Interest in self-help materials was positively related to intent to quit in the next 6 months and to low family income.

Adult↗
PubMed2003

The role of relevancy in normative feedback for university students' drinking patterns.

OBJECTIVE: Intervention studies using normative feedback have reported changes in motivation for changes in alcohol use. The relevancy of the social comparison group of the feedback has not yet been examined. The purpose of this study was to examine whether varying the relevancy of the comparison group would result in greater motivation for changes in alcohol use. METHOD: Participants completed the AUDIT and then read one of three intervention pamphlets: (i) Canadian population drinking patterns; (ii) Canadian university students' drinking patterns; or (iii) American university students' drinking patterns. Afterwards, participants completed the recognition and ambivalence subscales of SOCRATES and rated their overall impressions of the pamphlet. RESULTS: Participants identified as problem drinkers who read the American university students pamphlet reported significantly higher recognition ratings, compared to problem drinkers who read one of the other two pamphlets. CONCLUSIONS: Explanations for the unanticipated findings are discussed. The authors speculate that participants may have relied on their knowledge of perceived drinking patterns as opposed to relevancy of the feedback in making their social comparison.

Adult↗
PubMed2003

Comparison of a quick drinking screen with the timeline followback for individuals with alcohol problems.

OBJECTIVE: Two major strategies have typically been used to assess recent drinking: (1) Daily Estimation (DE) measures such as the Timeline Followback (TLFB) and (2) Quantity-Frequency (QF) summary measures. Although QF measures provide a quick and easy measure of consumption, they have been criticized as not being able to capture sporadic and unpatterned drinking (e.g., days that reflect important social and/or health risks). The TLFB, a psychometrically sound drinking assessment method, is able to capture all drinking, including sporadic heavy days and unpatterned drinking. In some situations, however, recall of daily drinking may not be possible or practical (e.g., limited time; no resources). This article compares results obtained by using a QF measure and a DE measure to assess problem drinkers' pretreatment drinking. METHOD: The current study, part of a large community mail intervention with 825 alcohol abusers, compared results from two drinking measures covering the same time interval that were administered on two different occasions approximately 2.5 weeks apart. Both measures, the Quick Drinking Screen (QDS; a QF summary measure that collected data by telephone) and the TLFB (a self-administered daily estimation measure), collected drinking data for the year prior to the interview. RESULTS: Although the QDS and the TLFB are very different drinking measures, remarkably similar aggregate drinking data were obtained for five drinking variables. CONCLUSIONS: When it is not necessary or possible to gather detailed drinking data, the QDS produces reliable brief summary measures of drinking, at least for not severely alcohol dependent individuals. Also, respondents do not appear to use a repetitive response pattern when completing the TLFB.

Adult↗
PubMed2002

Intravenous and non-intravenous cocaine abusers admitted to inpatient detoxification treatment: a 3-year medical-chart review of patient characteristics and predictors of treatment re-admission.

This naturalistic study examined the admissions and re-admissions of 341 intravenous (IV) and non-IV cocaine abusers over a 3-year period to an inpatient, hospital-based drug-and-alcohol detoxification treatment program. IV cocaine abusers reported higher rates of residential instability, unemployment, Hepatitis C, HIV and cirrhosis than non-IV cocaine abusers. In addition, IV cocaine abusers were administered more medical evaluative tests during treatment and accessed inpatient detoxification treatment more often during the 3-year study period. A Cox regression model demonstrated that residential instability and IV route of cocaine administration were significant predictors of inpatient detoxification re-admission. In light of the important differences between IV and non-IV cocaine-abusing groups, detoxification services should view route of cocaine administration as a key topic in treatment delivery and residential stability as an important topic in the discharge-and-referral process.

Adult↗
PubMed2002

Gender differences in detoxification: predictors of completion and re-admission.

This study examined the medical records of 2595 consecutive admissions over a 3-year period to an inpatient mixed-gender, hospital-based alcohol and drug detoxification unit. Women reported a significantly different pattern of primary drug use, a younger age, a different pattern of referral sources, and higher rates of parenting status and unemployment. In addition, females were administered prescription medication and medical evaluation tests at a significantly higher rate than males. Multiple regression analyses demonstrated that an opiate as a primary drug of choice was a significant risk factor for dropout. Risk factors for re-admission to inpatient detoxification included: alcohol as a primary drug of choice, residential instability, multiple drug use, single marital status, unemployment, an older age (> 37 years), and treatment dropout at Time 1 in the study. For both the final prediction models, gender was not a significant factor. The treatment implications of these findings are discussed.

Adult↗
PubMed2002

Treating alcohol problems with self-help materials: a population study.

OBJECTIVE: An experimental trial was used to assess the effectiveness of a self-help book and a personalized assessment-feedback intervention, both separately and in combination with each other, in a general population survey. METHOD: Participants (N = 86; 66.3% male) were recruited through a random digit dialing telephone survey conducted by the Centre for Addiction and Mental Health, Toronto, Ontario, Canada. Respondents were randomly assigned to one of four conditions in a two-by-two factorial design: "no-intervention" control group, "personalized feedback only," "self-help book only" and "both personalized feedback and self-help book." Respondents were followed up in 6 months' time, and differences in drinking status were compared between experimental conditions using a multivariate analysis of covariance with baseline drinking severity as the covariate. RESULTS: Support was provided for an interaction hypothesis in which respondents who received both interventions reported significantly improved drinking outcomes at 6-month follow-up, compared with respondents who received just one of the interventions or who received no intervention. CONCLUSIONS: Because respondents were recruited from a representative sample of the general population into a randomized trial with a no-intervention control group, this research design maximized both external and internal validity in examining the effectiveness of self-help interventions.

Alcohol Drinking↗
PubMed2002

Promoting self-change with alcohol abusers: a community-level mail intervention based on natural recovery studies.

BACKGROUND: By using a public health approach to the treatment of alcohol problems, this study analyzed the efficacy and cost analysis of two versions of a community-level mail intervention to promote self-change among alcohol abusers who had never sought help or treatment. METHODS: A total of 825 participants who responded to media solicitations were randomly assigned to one of two interventions: (a) for bibliotherapy/drinking guidelines (n = 411), they were given two pamphlets with information about the effects of alcohol and guidelines for low-risk drinking and self-monitoring, and (b) for motivational enhancement/personalized feedback (n = 414), personalized advice/feedback was provided on the basis of the participants' assessment of their drinking and related behaviors. RESULTS: Although both groups exhibited significant reductions in drinking from 1 year before to 1 year after intervention, there were no significant differences between the two interventions for any variable. This suggests that the materials, irrespective of whether they were personalized, facilitated the reduction of drinking. Cost analysis revealed that a brief mail intervention could reduce drinking at a very low cost per participant (US$46 to US$97). CONCLUSIONS: A brief community-level mail intervention for problem drinkers who had never sought treatment resulted in sizable reductions in alcohol use over the year after the intervention compared with the year before. Furthermore, many of those with poorer outcomes engaged in a natural stepped-care process by seeking help. These results, coupled with the low cost to deliver the intervention, suggest that public health campaigns could have a substantial effect on reducing alcohol problems and associated costs as well as getting some individuals into treatment. Such an approach would represent a shift from the alcohol field's long-standing clinical focus to a broader public health perspective.

Adult↗
PubMedDate not supplied

Stopping illicit drug use without treatment: any relation to frequency of drug use?

Using data from a large, representative survey of the U.S. population, the relation between frequency of prior drug use and treatment utilization was explored. As was hypothesized, the more frequently former drug users had taken an illicit drug, the more likely they were to have accessed treatment. This relationship was true for all illicit drug classes.

Adolescent↗
PubMedDate not supplied

The anatomy, affinity, and phylogenetic significance of Markuelia.

The fossil record provides a paucity of data on the development of extinct organisms, particularly for their embryology. The recovery of fossilized embryos heralds new insight into the evolution of development but advances are limited by an almost complete absence of phylogenetic constraint. Markuelia is an exception to this, known from cleavage and pre-hatchling stages as a vermiform and profusely annulated direct-developing bilaterian with terminal circumoral and posterior radial arrays of spines. Phylogenetic analyses have hitherto suggested assignment to stem-Scalidophora (phyla Kinorhyncha, Loricifera, Priapulida). We test this assumption with additional data and through the inclusion of additional taxa. The available evidence supports stem-Scalidophora affinity, leading to the conclusion that scalidophorans, cyclonerualians, and ecdysozoans are primitive direct developers, and the likelihood that scalidophorans are primitively metameric.

Animals↗
PubMedDate not supplied

Fossilized embryos are widespread but the record is temporally and taxonomically biased.

We report new discoveries of embryos and egg capsules from the Lower Cambrian of Siberia, Middle Cambrian of Australia and Lower Ordovician of North America. Together with existing records, embryos have now been recorded from four of the seven continents. However, the new discoveries highlight secular and systematic biases in the fossil record of embryonic stages. The temporal window within which the embryos and egg capsules are found is of relatively short duration; it ends in the Early Ordovician and is roughly coincident with that of typical "Orsten"-type faunas. The reduced occurrence of such fossils has been attributed to reducing levels of phosphate in marine waters during the early Paleozoic, but may also be owing to the increasing depth of sediment mixing by infaunal metazoans. Furthermore, most records younger than the earliest Cambrian are of a single kind-large eggs and embryos of the priapulid-like scalidophoran Markuelia. We explore alternative explanations for the low taxonomic diversity of embryos recovered thus far, including sampling, size, anatomy, ecology, and environment, concluding that the preponderance of Markuelia embryos is due to its precocious development of cuticle at an embryonic stage, predisposing it to preservation through action as a substrate on which microbially mediated precipitation of authigenic calcium phosphate may occur. The fossil record of embryos may be limited to a late Neoproterozoic to early Ordovician snapshot that is subject to dramatic systematic bias. Together, these biases must be considered seriously in attempts to use the fossil record to arbitrate between hypotheses of developmental and life history evolution implicated in the origin of metazoan clades.

Animals↗