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Biomedical subjects

M O Howard

Publications and source records attributed to M O Howard.

At least 37 records · Page 2Linked to original sources
PubMed1995

Diagnosis and hospital readmission rates of female veterans with substance-related disorders.

OBJECTIVES: The study examined the prevalence of substance use, psychiatric, and medical disorders in female veterans discharged from VA hospitals. METHODS: The VA discharge abstract database was used to identify women discharged in fiscal year 1991 who received a diagnosis of substance abuse or dependence or substance-induced psychosis (N = 1,698). They were compared with female veterans who did not receive a substance-related diagnosis (N = 12,037). RESULTS: Alcohol and cocaine use disorders were the most prevalent substance use disorders. Women with substance use disorders were more frequently diagnosed as having personality disorders, depression, and posttraumatic stress disorder than women without substance use disorders. Skin and subcutaneous tissue diseases, infectious and parasitic diseases, and digestive diseases were more prevalent among women with substance use disorders than among women in the same age group who did not have substance use disorders. Approximately 44 percent of women with substance use disorders who were discharged during the first six months of fiscal year 1991 were rehospitalized within that year. CONCLUSIONS: Substance use disorders and associated comorbidities are endemic among women treated in VA hospitals. Additional studies examining characteristics of indigent women with substance use disorders are needed.

Adult↗
PubMed1995

Treatment of adolescent substance abusers: issues for practice and research.

Treatment of adolescent substance abuse poses difficult challenges to social work practitioners. Effective intervention requires awareness of assessment and treatment approaches and knowledge of individual, peer, and family factors that contribute to alcohol or drug use. Social work's emphasis on contextual factors in the etiology and maintenance of addictive disorders is an important contribution to substance abuse treatment. Practitioners are in an excellent position to implement interventions addressing multiple causes of substance abuse. This paper discusses the prevalence of alcohol and drug use among adolescents in the United States. Assessment issues are identified and promising approaches to treating adolescents with substance use problems are noted. Implications for social work practice and research are delineated.

Adolescent↗
PubMed1995

Characteristics of substance-abusing veterans attempting suicide: a national study.

Demographic, diagnostic, and service utilization characteristics of veterans diagnosed with suicide attempt, substance dependence, both, or neither at discharge from Department of Veterans Affairs (DVA) hospitals in fiscal year 1994 (FY94) were compared using the DVA's discharge abstract database. Four groups of veterans were studied: (1) substance-abusing suicidal inpatients (n = 1,459), (2) substance-abusing nonsuicidal inpatients (n = 123,808), (3) nonsubstance-abusing suicidal inpatients (n = 632), and (4) nonsubstance-abusing nonsuicidal inpatients (n = 402,906). Substance-abusing suicidal veterans had higher rates of substance abuse than substance-abusing nonsuicidal veterans. Substance-abusing suicidal veterans had a higher mean number of inpatient treatment episodes and a larger proportion of discharges against medical advice than the other three inpatient groups. Psychiatric and substance use disorders are more prevalent among substance-abusing suicidal veterans than among veterans with only substance use disorders or suicidal conduct.

Adult↗
PubMed1994

Psychiatric and medical comorbidities of veterans with substance use disorders.

OBJECTIVE: The authors examined patterns of substance use disorders and psychiatric and medical comorbidity in all male veterans treated in Veterans Affairs (VA) medical centers during a one-year period. METHODS: A national discharge abstract data base was used to derive point prevalence rates of psychiatric and medical disorders for 539,557 inpatients treated in VA medical centers in fiscal year 1991. RESULTS: Nearly one-quarter of all male veterans treated in the study year had a substance-related diagnosis. The most prevalent substance use disorders were alcohol dependence (87.7 percent) and cocaine dependence (17.5 percent), and the most frequent psychiatric diagnoses among veterans with substance-related diagnoses were depression and personality disorders. Digestive disorders were more prevalent among veterans who abused substances than among veterans who did not, and veterans who abused substances were also more likely to have multiple hospitalizations and longer index hospital stays. CONCLUSIONS: Substance use disorders and comorbid psychiatric syndromes are common in male veterans treated in VA hospitals. Veterans with substance-related diagnoses may have longer hospital stays and more frequent hospitalizations than veterans without substance use disorders.

Adult↗
PubMed1994

Drug dependence treatment within the Department of Veterans Affairs: emerging issues.

The Department of Veterans Affairs is the largest provider of drug dependence treatment services in the United States. However, a national evaluation of primarily drug-dependent veterans has never been reported. Findings from the Drug Abuse Treatment Services Evaluation Project, a three-year investigation of drug dependence treatment within the Department of Veterans Affairs, are discussed. Demographic and diagnostic data are presented for the population of 46,047 inpatients discharged with drug dependence diagnoses in Fiscal Year 1991. Patient subtypes and clinical issues of growing relevance to the treatment of drug-dependent veterans are discussed.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Medical practice guidelines.

Prescriptive standards of clinical conduct--practice guidelines--have proliferated throughout medicine over the past decade. Practicing physicians are confronted with a plethora of guidelines developed for different purposes by a diverse body of public and private organizations. We review factors contributing to the growth of guidelines, their desirable features, and consequences, legal and otherwise, of implementing guidelines. Few studies have examined whether, and under what conditions, guidelines are effective in changing physicians' practices and patients' health. Nonetheless, expectations for guidelines remain high because they are one of the only instruments of health care reform that promises to improve the quality of care while reducing overall health care costs. Efforts to develop guidelines are likely to continue unabated for the foreseeable future. Additional research comparing different methods of developing and disseminating guidelines is needed.

Practice Guidelines as Topic↗
PubMed1993

Assessing the comparative cost-effectiveness of alcoholism treatments: a comment on Holder, Longabaugh, Miller and Rubonis.

Holder, Longabaugh, Miller and Rubonis (JSA, vol. 53, pp. 517-540, 1991) discuss the shortcomings of the empirical literature relevant to an assessment of the comparative cost-effectiveness of alcoholism treatment modalities. Their analysis is rooted in an attempt to conjoin the literatures pertaining to clinical efficacy and costs of alcohol dependence treatment. Holder et al.'s methodology is flawed in a number of respects and they exceed the bounds of the evidence when they endorse particular treatment modalities as comparatively cost-effective. Generalizations as to the relative cost-effectiveness of particular modalities are forwarded despite the fact that treatments are applied to persons with alcohol problems of widely varying severity. Additional points of contention are raised regarding the authors' selection of acceptable studies and interpretation of findings. Despite these limitations, Holder et al.'s (1991) analysis is a seminal heuristic contribution to the discussion of cost-effectiveness in the alcoholism field.

Alcoholism↗
PubMed1992

Citation analysis of 541 articles published in drug and alcohol journals: 1984-1988.

Citation histories of 541 articles published in 1984 in 12 drug and alcohol journals were followed through 1988. Considerable variability in mean citation rates across journals was observed. The mean citation rate for the 541 articles was 3.48. Approximately 71% of the articles examined were cited at least once between 1984 and 1988. The present findings suggest that articles published in drug and alcohol journals may be cited more frequently, and exert their influence longer, than those of the social science literature generally. Qualitative analyses suggest that methodological and review articles tend to be cited most frequently. The need for a comprehensive scientometric examination of the drug and alcohol literature is emphasized as is the potential role of multivariate techniques in the identification of variables predictive of individual article and journal citation rates.

Adult↗
PubMed1991

Chemical aversion treatment of alcohol dependence.

Developments in the application of chemical aversion therapy to the treatment of alcohol dependence are discussed. Historical factors leading to the early use of chemical aversion therapies are delineated and the theoretical underpinnings of chemical aversion interventions are evaluated. Ethical and procedural considerations are addressed and an assessment of the efficacy of the therapy is attempted. Future research activities that would lead to refinement of chemical aversion therapy protocols are highlighted. The effectiveness of chemical aversion treatment of alcohol dependence is discussed vis-a-vis production of condition alcohol-aversion and treatment outcome.

Alcoholism↗
PubMed1991

Comparative biochemical and morphometric changes associated with induction of the hepatic mixed function oxidase system in the rat.

This study characterized the induction of the rat hepatic cytochrome P-450-dependent mixed function oxidase system by SK&F 86002 [6-(4'-fluorophenyl)-5-(4'-pyridyl)-2,3-dihydroimidazo-(2,1-b)thia zole], an inhibitor of both the cyclooxygenase and 5-lipoxygenase pathways of arachidonic acid metabolism. The induction characteristics of SK&F 86002 were compared to those of the classical inducer, phenobarbital, and morphological features of both SK&F 86002 and phenobarbital induced hepatocellular hypertrophy were quantitated. Rats were administered either SK&F 86002 (6, 18, or 60 mg/kg/day, po) or phenobarbital (8, 24, 80 mg/kg/day, ip) for 3 or 14 consecutive days. Liver to body weight ratio, total hepatic microsomal protein and cytochrome P-450 content, ethoxycoumarin-O-deethylase (ECOD) and leukotriene B4(LTB4) omega- and omega-1 hydroxylase were measured. Ultrastructural morphometry of the liver from control, and high dose SK&F 86002 (60 mg/kg/day) and phenobarbital (80 mg/kg/day) treated rats was completed. On day 3, phenobarbital increased liver to body weight ratio but only at the 80 mg/kg/day dosage; microsomal protein content was unchanged. ECOD activity increased in a dose-dependent fashion. LTB4 omega- and omega-1 hydroxylase activities were unaffected. Administration of SK&F 86002 for 3 days increased the liver to body weight ratio at both the 18 and 60 mg/kg/day dosage; microsomal protein content was unchanged. ECOD activity was significantly increased by the 60 mg/kg/day dosages of SK&F 86002. On day 14, phenobarbital increased the liver to body weight ratio and microsomal protein content but again only at the 80 mg/kg/day dosage. Cytochrome P-450 content was increased by all dosages.(ABSTRACT TRUNCATED AT 250 WORDS)

7-Alkoxycoumarin O-Dealkylase↗
PubMed1991

Environmental risks to be considered in substance user treatment planning, implementation, and assessment.

The therapeutic process made during treatment is often negated by adverse factors in the patient's social environment. Relapse is often associated with addictive use of alcohol or other drugs by the spouse or other close personal associates. A major emphasis of every aftercare plan should be to effectively deal with these addicted individuals in the patient's environment. Ideally the adverse effects will be eliminated by successfully treating the significant other's own addiction. Failing that, other appropriate strategies should be employed to protect the patient from his or her relapse-inducing adverse influences.

Aftercare↗
PubMed1990

Chemical aversion treatment of alcohol dependence. II. Future research directions for the '90s.

Chemical aversion treatment is one of the most promising modalities currently available for treatment of alcohol dependence. This review highlights potentially fruitful areas for future investigational efforts and poses a number of specific empirical questions. Investigation of issues delineated in this report would advance understanding of pharmacological aversion therapy vis-à-vis utility and mechanisms of action.

Alcohol Deterrents↗
PubMed1990

Chemical aversion treatment of alcohol dependence. I. Validity of current criticisms.

Current criticisms of chemical aversion therapy are delineated and their validity assessed. Data pertaining to the effectiveness, acceptability, intrusiveness, availability of alternative treatments, cost-effectiveness, and theoretical foundations of chemical aversion therapy are examined. It is concluded that available evidence supports the efficacy of chemical aversion therapy with respect to production of conditioned aversion to alcohol and treatment outcome.

Alcohol Deterrents↗
PubMedDate not supplied

Practice guidelines in the addictions. Recent developments.

Consensually established principles of clinical conduct, known variously as practice guidelines, standards, protocols, or algorithms, have proliferated throughout medicine over the past decade. Institutional and disciplinary efforts to develop and promulgate guidelines for the treatment of additive disorders have recently been initiated. We review guideline development activities of the American Psychiatric Association, American Psychological Association, American Society of Addiction Medicine, American Nurses Association, National Association of Social Workers, and Center for Substance Abuse Treatment of the Substance Abuse and Mental Health Services Administration. Medical care performance and outcome assessments are discussed with attention to the role they can play in evaluating and refining guidelines. Potential effects of guidelines, salutary and deleterious, on clinical practice in the addictions are delineated.

Forecasting↗
PubMedDate not supplied

Inhalant use among antisocial youth: prevalence and correlates.

The current (2.9%), annual (19.6%), and lifetime (34.3%) prevalence of inhalant use among 475 youth (M age = 15.5; SD = 1.5; 87.4% male) on probation in a western state of the United States was assessed. Inhalant users reported significantly less family support and cohesiveness and lower self-esteem, and significantly more lifetime thoughts of suicide and suicide attempts, neighborhood gang activity, peer and parental substance abuse, intentions to engage in illegal behavior, substance-related criminality, and substance abuse than did nonusers. Ethnicity, self-esteem, suicidality, number of substance-using peers, and extent of substance-related criminality significantly discriminated inhalant users from nonusers in a logistic regression analysis. Multiple linear regression analyses indicated that age, perceived school ability, age at initiation of alcohol use, self-esteem, and substance-related criminality significantly predicted age at onset of inhalant use (R2 = .30). Age at initiation of inhalant use, gang membership, truancy, and substance-related criminality significantly predicted lifetime frequency of inhalant use (R2 = .20). Study findings indicate that inhalant-using delinquents evidence significantly greater antisocial attitudes, personal and familial dysfunction, and substance abuse, than do their non-inhalant-using counterparts.

Administration, Inhalation↗
PubMedDate not supplied

In vitro metabolism of the novel antiinflammatory agent 6-(4'-fluorophenyl)-5-(4'-pyridyl)-2,3-dihydroimidazo-[2,1-b]-thiazole.

6-(4'-Fluorophenyl)-5-(4'-pyridyl)-2,3-dihydroimidazo-[2,1-b]-thia zole (SK&F 86002) is a dual inhibitor of arachidonic acid metabolism which has therapeutic potential for the treatment of inflammatory diseases. Previous studies in rats, in vivo, demonstrated that SK&F 86002 metabolism proceeds by sequential steps of sulfur and nitrogen oxidation. Therefore, these studies were designed to 1) identify the enzymes (flavin vs. cytochrome P-450-dependent monooxygenases) which were responsible for SK&F 86002 metabolism in vitro in hepatic microsomal suspensions from Sprague-Dawley rats, 2) characterize sex-dependent differences, and 3) quantitate the effect of pretreatment with SK&F 86002. All three steps in the sequential metabolism of SK&F 86002 to the N-oxide sulfone metabolite were quantitated individually. The three oxidation steps appeared to be catalyzed primarily by cytochrome P-450; heat inactivation (used to destroy flavin monooxygenase) had little effect on the metabolism of each compound. Further,N-octylamine failed to stimulate the metabolism of any compound and the cytochrome P-450 inhibitors (SK&F 525-A, metyrapone, and alpha-naphthoflavone) resulted in a marked inhibition of the metabolism of all three substrates. Maximal velocities for metabolism of all three substrates (SK&F 86002, sulfoxide, and sulfone) in microsomes isolated from male rats, were 3- to 5-fold greater than observed in female rats. Furthermore, pretreatment of male rats with SK&F 86002 (60 mg/kg/day for 3 days) resulted in a change in the in vitro metabolism of all three substrates generally characterized by an increase in Vmax and/or a fall in km.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗