Biomedical subjects

John Lynch

Publications and source records attributed to John Lynch.

60 records · Page 4Linked to original sources

PubMed2002

Life course socioeconomic conditions and adult psychosocial functioning.

BACKGROUND: Various psychosocial factors have been linked to adult physical health and are also associated with socioeconomic position in adulthood. We evaluated the effect of socioeconomic conditions over the life course on measures of psychosocial functioning in adulthood. METHODS: Life course socioeconomic position was assessed by retrospective recall of parents' education and occupation when the respondent was age 10, and the respondents' education, occupation, and income in 2585 men from eastern Finland aged 42, 48, 54, and 60 years. Measures of psychosocial functioning were derived from scales measuring cynical hostility, hopelessness, and depressive symptoms. RESULTS: Men with both parents who had less than a primary school education or who both had unskilled manual jobs had higher age-adjusted levels of cynical hostility, hopelessness, and depressive symptoms in adulthood. Mutually adjusted analyses showed that parents' education and the respondents' education, occupation, and income all had statistically independent effects on adult levels of cynical hostility and hopelessness. For instance, men for whom neither parent had completed primary education had a 0.15 standard deviation (P = 0.006) higher cynical hostility score, and a 0.20 standard deviation (P = 0.00018) higher hopelessness score, after adjustment for education, occupation and income. In contrast, depressive symptoms in adulthood were only associated with the respondent's occupation and income. CONCLUSIONS: Childhood socioeconomic position was associated with adult psychosocial functioning, but these effects were specific to some aspects of adult psychosocial functioning--cynical hostility and hopelessness, but not depressive symptoms. Adult occupation and income were associated with all measures of psychosocial functioning. In addition to the impact of adult socioeconomic position, some aspects of poor psychosocial functioning in adulthood may also have socioeconomic roots early in life.

Adult↗

PubMed1995

Validation of World Health Organization Guidelines for cancer pain relief: a 10-year prospective study.

This paper reports on the experience gained using World Health Organization Guidelines for cancer pain relief over a 10-year period in an anaesthesiology-based pain service associated with a palliative care programme. The course of treatment of 2118 patients was assessed prospectively over a period of 140,478 treatment days. Non-opioid analgesics (WHO step I) were used on 11%, weak opioids (WHO step II) on 31% and strong opioids (WHO step III) on 49% of treatment days. Administration was via the enteral route on 82% and parenterally on 9% of treatment days. On the remaining days, either spinally applied opioids (2%) or other treatments (6%) were utilised. Fifty-six percent of the patients were treated with morphine. Morphine dose escalation was observed in about one-half of the patients being cared for until death, whereas the other half had stable or decreasing doses over the course of treatment. Co-analgesics were administered on 37% of days, most often antidepressants (15%), anticonvulsants (13%) and corticosteroids (13%). Adjuvants to treat symptoms other than pain were prescribed on 79% of days, most commonly laxatives (42%), histamine-2-receptor antagonists (39%) and antiemetics (35%). In addition, palliative antineoplastic treatment was performed in 42%, nerve blocks in 8%, physiotherapy in 5%, psychotherapy in 3% and TENS in 3% of patients. A highly significant pain reduction was achieved within the 1st week of treatment (P < 0.001). Over the whole treatment period, good pain relief was reported in 76%, satisfactory efficacy in 12% and inadequate efficacy in 12% of patients. In the final days of life, 84% rated their pain as moderate or less, while 10% were unable to give a rating. Analgesics remained constantly effective in all 3 steps of the WHO ladder. Other clinical symptoms were likewise significantly reduced at 1 week after initial assessment, with the exception of neuropsychiatric symptoms. During the course of treatment, the latter were the major symptoms on 23% of days, followed by nausea (23%), constipation (23%) and anorexia (20%). Our results emphasise once again the marked efficacy and low rate of complications associated with oral and parenteral analgesic therapy as the mainstay of pain treatment in the palliative care of patients with advanced cancer. Wide dissemination of WHO guidelines among doctors and healthcare workers is thus necessary to effect a clear improvement in the treatment of the many patients suffering from cancer pain in the clinical and home setting.

Adolescent↗

PubMed1992

Transdermal fentanyl and initial dose-finding with patient-controlled analgesia in cancer pain. A pilot study with 20 terminally ill cancer patients.

This pilot study evaluated the efficacy and side effects of a combination of initial patient-controlled analgesia (PCA) for dose-finding with transdermal fentanyl administration. Twenty inpatients, requiring strong opioids for severe cancer pain, received intravenous fentanyl on an on-demand basis over a 24-h period. The amount of fentanyl administered was then used as a guideline for selecting a suitable transdermal therapeutic system (TTS) on the 2nd day, which remained in place for 3 days. The size of a 2nd TTS, being used from day 5 to 7, was adjusted according to the amount of supplementary intravenous fentanyl doses on day 3. From day 4 to 7 intravenous fentanyl was stopped, and subcutaneous morphine was made available as a rescue medication. A standardized adjuvant medication was allowed. Pain intensity, pain relief, quality of sleep, mood, general state of health, activity, mobility, rescue morphine consumption and side effects were assessed using a diary after baseline pain and symptoms were recorded. Vital functions were monitored and fentanyl plasma levels were measured daily in 15 patients. The use of TTS fentanyl in combination with initial dose titration using PCA gave rapid and statistically significant pain relief. Patient compliance and acceptance were excellent. In the absence of severe side effects the main complaints were dryness of the mouth and constipation. Increasing pain intensity and increasing supplementary morphine requirements as well as decreasing plasma fentanyl levels on day 7 may indicate that conversion ratios from intravenous to transdermal administration should be increased or that TTS should be changed earlier.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Cutaneous↗

PubMedDate not supplied

A common LRRK2 mutation in idiopathic Parkinson's disease.

Mutations in the leucine-rich repeat kinase 2 (LRRK2) gene have been shown to cause autosomal dominant Parkinson's disease. Few mutations in this gene have been identified. We investigated the frequency of a common heterozygous mutation, 2877510 g-->A, which produces a glycine to serine aminoacid substitution at codon 2019 (Gly2019 ser), in idiopathic Parkinson's disease. We assessed 482 patients with the disorder, of whom 263 had pathologically confirmed disease, by direct sequencing for mutations in exon 41 of LRRK2. The mutation was present in eight (1.6%) patients. We have shown that a common single Mendelian mutation is implicated in sporadic Parkinson's disease. We suggest that testing for this mutation will be important in the management and genetic counselling of patients with Parkinson's disease.

Adult↗

PubMedDate not supplied

Cynical hostility, socioeconomic position, health behaviors, and symptom load: a cross-sectional analysis in a Danish population-based study.

OBJECTIVE: To analyze the cross-sectional association between cynical hostility and high symptom load in a Danish population-based study. Furthermore, the aim was to investigate to what extent health risk behaviors mediated this association. METHODS: Data were based on a postal questionnaire in a Danish random sample of 3426 men and 3699 women aged 40 or 50 years. Cynical hostility was measured by the 8-item Cynical Distrust Scale. High symptom load was assessed by physiological and mental symptoms experienced within the last 4 weeks. Confounders were age and socioeconomic position, while potential mediators were alcohol consumption, smoking, physical activity, and BMI. RESULTS: Higher cynical hostility was associated with self-reported symptom load. Health behaviors did not seem to mediate this effect. Socioeconomic position was a strong confounder for the effect on both health and health behaviors. After adjustment the effects of hostility on health remained with odds ratios of 2.1 (1.7-2.6) for women and 2.3 (1.8-2.8) for men. CONCLUSION: After adjustment for socioeconomic position, cynical hostility has an effect on self-reported high symptom load, and this effect is not mediated by health behaviors.

Adult↗

PubMedDate not supplied

Genes and race in the news: a test of competing theories of news coverage.

OBJECTIVES: To examine newspaper coverage of race and genetics to identify patterns and possible explanations for them in extant theory in order to improve health promotion campaigns. METHODS: Articles from Lexus-Nexus database fitting the search criteria were coded according to themes developed from the scientific literature and a prereading of texts. RESULTS: Articles present an array of attitudes toward race and genetics. No existing theory explains this pattern. CONCLUSION: Because newspapers present both sides of the scientific debate, health promotion messages dealing with race, genetics, and medicine must address both sides of the debate in order to be effective.

Gene Expression↗