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Biomedical subjects

R W Edwards

Publications and source records attributed to R W Edwards.

At least 19 recordsLinked to original sources

Links from emotional distress to adolescent drug use: a path model.

Administered anonymous surveys asking about drug use, emotional distress, and peer drug associations to 11th and 12th grade high school students (N = 563). Emotional distress variables accounted for only 4.8% of the variance in drug use. The addition of peer drug associations as a predictor variable increased the variance accounted for to 43.4%. A path model of adolescent drug use based on peer cluster theory was tested using LISREL, and this provided a good fit with the data. As predicted, peer drug associations dominated the prediction of drug use and mediated the effect of emotional distress on drug use, with the exception of a small residual path directly from anger to drug use. The hypothesis that young people take drugs to alleviate emotional distress does not hold up well; emotional distress variables, with the exception of anger, produced only very small and indirect links to drug use.

Adolescent

A clinical trial of intraligamentary anesthesia.

The effectiveness of the periodontal ligament injection in providing anesthesia for routine extractions and the possible mechanisms of action of the periodontal ligament injection in producing dental anesthesia were investigated in a clinical trial. Periodontal ligament injections were administered under strong pressure with lidocaine on 14 teeth, with epinephrine on seven teeth, and with normal saline on another seven teeth. The anesthesia attained was evaluated by: response of the teeth to an electric pulp tester, gingival probing around the teeth, and the ability for teeth to be extracted without pain. The results demonstrated that periodontal ligament injections with lidocaine were effective in providing adequate anesthesia for the performance of dental extractions. Lidocaine periodontal ligament injections were statistically and clinically more effective in attaining anesthesia than were epinephrine or saline injections. Epinephrine periodontal ligament injections resulted in a slight but statistically significant increase in the stimulus necessary to produce a patient response, when the teeth were stimulated with an electric pulp-tester. Saline injections produced no change in response to the stimulus tested. It appears, based on the results of the saline and epinephrine injections, that hydrostatic pressure had no direct effect on the production of anesthesia with the periodontal ligament injection.

Adolescent

Adult acute lymphoblastic leukemia: results of the Iowa HOP-L protocol.

Fifty-nine consecutive previously untreated adult patients with acute lymphoblastic leukemia (ALL) were entered onto a prospective single-arm trial of doxorubicin, vincristine, prednisone, and asparaginase (HOP-L) induction therapy followed by CNS prophylaxis and 3 years of maintenance therapy. Consolidation therapy was not administered. The study population included a large number of older (greater than 50 years) patients. Seventy-five percent of patients achieved complete remission. With a median follow-up of 6 years, the median duration of complete remission is greater than 4 years, with 53% of patients expected to remain in remission at both 3 and 5 years. Overall, median survival duration is 27.9 months, with 45% and 35% of all patients expected to survive 3 and 5 years, respectively. Multivariate analysis identified patients with T-cell disease and mediastinal masses (P less than .001) and those with low values of lactic dehydrogenase (LDH) (P = .057) as being at greatest risk of relapse. Therapy was well tolerated by patients under age 35, but older patients suffered appreciable mortality. We conclude that this treatment program is effective therapy for adult ALL, yielding a large proportion of durable remissions despite the exclusion of consolidation therapy.

Adolescent

American Indian youth and drugs, 1976-87: a continuing problem.

Continuing surveillance of drug use among American Indian adolescents living on reservations shows them to have rates of use higher than those of their non-Indian counterparts. Marijuana use is particularly high among Indian students. By the 7th grade a significant number of Indian youth have tried drugs, particularly marijuana and alcohol, and there are few significant differences by gender. Based on observed patterns of use, intervention strategies need to begin in the elementary school years and target both males and females equally.

Adolescent

Indian and Anglo adolescent alcohol use and emotional distress: path models.

Anonymous surveys of alcohol use and emotional distress of 11th and 12th grade students were administered to 327 reservation Indian adolescents and 524 Anglo adolescents. Path models based on peer cluster theory were developed and tested. Results argue against a self-medication theory of adolescent alcohol use. Emotional distress variables had little effect on alcohol involvement, with the exception of anger which operated in opposite directions for the two groups. The highest relationship with alcohol involvement in both groups was with peer alcohol associations, confirming the a priori hypothesis that much of adolescent alcohol use is linked to peer associations. Those relationships, however, were much stronger in Anglo youth, suggesting that alcohol may be used more frequently in nonpeer situations by Indian youth, or at least in situations where the peers are not those close friends who have very similar patterns of alcohol use. The most important difference between Indian and Anglo youth, however, may be the role that anger plays in alcohol involvement. In Anglo youth, anger may be associated with problem behaviors including alcohol use. In Indian youth, higher anger is linked to higher self-esteem, and tends to reduce alcohol use.

Adolescent

Social and psychological factors underlying inhalant abuse.

There are three distinct types of inhalant users: young inhalant users, adolescent polydrug users, and inhalant-dependent adults. Young inhalant users have a modal age of 12 to 13. They use inhalants and may also use alcohol and marijuana. They are likely to have more emotional problems than nondrug users or young marijuana users. These problems, particularly when they involve feelings of anger and alienation, increase the chances that they will identify with other youth who have similar feelings. When this happens, young people form peer clusters; they find a best friend or form a small gang that has a high potential for getting involved with drugs. Most of these peer clusters use inhalants only a few times a month, although some may become obsessed with inhalant use to the exclusion of nearly all other activities. The data showing that young inhalant users have more emotional problems than either nondrug users or young marijuana users suggest that treatment should involve therapy as well as drug avoidance approaches. Every youth caught using inhalants, however, should not automatically be sent for therapy. Sometimes a youth caught using a drug is not really drug involved and overreaction can be damaging. In addition, the emotional problems of all young inhalant users are not identical. A higher average level of emotional problems only means that some of the young inhalant users have those problems, not all of them. Older adolescents, including those who used inhalants earlier, are not likely to use inhalants. Since young inhalant users seem to be troubled youth, have shown an early penchant for drug use, and have drug-using associates, it seem unlikely that they quit using drugs. They probably move on to other drugs, leaving inhalants behind. The older adolescents who do use inhalants are adolescent polydrug users, with a modal age of around 15 to 16. They take many different drugs, and some of them use inhalants as well. The adolescents who use inhalants are probably using a wider range of drugs than other adolescents and are probably getting high more often. Furthermore, they are likely to be more deviant and may be involved in more aggression and more crime. Inhalant-dependent adults usually have a long history of alcohol and other drug involvement. At some point, inhalants have become their preferred drug. By that time, they are usually in their midtwenties to early thirties. They have serious problems.(ABSTRACT TRUNCATED AT 400 WORDS)

Administration, Inhalation

Trends in drug use of Indian adolescents living on reservations: 1975-1983.

Anonymous surveys on drug use were administered to 7th-12th grade students in Indian reservation schools. A large number of tribes were surveyed from 1975 through 1983. There is reason to believe the results are reasonably representative of Indian youth living on reservations. Lifetime prevalence for most drugs is higher than that for non-Indian youth throughout this period, and rates for alcohol, marijuana, and inhalants, the most frequently tried drugs, were particularly high. Since 1981 there has been a slight drop in lifetime prevalence for most drugs. Current use figures show the same trends, with increasing current use through 1981 and a drop since that time. Analysis of patterns of drug use, classifying youth according to number, type, and depth of involvement with drugs, shows a similar trend, with radical increases until 1981 and then a drop in all but one of the more serious drug use types. Despite this drop, 53% of Indian youth would still be classified as "at risk" in their drug involvement, compared with 35% of non-Indian youth. Reasons probably relate to severely detrimental conditions on reservations; unemployment, prejudice, poverty, and lack of optimism about the future.

Adolescent

Long-term relapse-free survival in adult acute lymphoblastic leukemia.

An intensive treatment program with curative intent was designed for adults with acute lymphoblastic leukemia (ALL). Forty-eight consecutive patients were treated with this protocol and 39 (81%) obtained a complete remission. Although the complete remission rate was high for patients with both null- and T-cell disease, those with null-cell leukemia had a significantly greater median duration of remission (greater than 306 weeks) than patients with T-cell disease (62 weeks). The median survival by life-table analysis for the 48 patients is projected to be greater than 310 weeks, and five patients have finished the 3-year treatment program and have been off therapy for 1-3 years without recurrence of disease. Classification of adult ALL by immune marker status is an important and easily done pretherapy maneuver that identifies subsets of patients with a significantly different prognosis when treated with the protocol described in this study. Those patients for whom leukemic cells had T-cell characteristics had a short median duration of remission. Most importantly, this treatment protocol identifies by therapeutic response a subset of adult patients with ALL whose leukemic blasts are characterized by the absence of immunological markers and who appear, in substantial proportion, to be potentially curable.

Actuarial Analysis

The partial characterization of 1-oxygenated steroids from urine of a hypertensive newborn child.

1. Four substances from the urine of a hypertensive newborn girl were partially characterized and shown to be 17alpha-hydroxy-5beta-pregnane-1,3,20-trione, 3alpha,17alpha-dihydroxy-5beta-pregnane-1,20-dione, 3alpha,17alpha,20alpha-trihydroxy-5beta-pregnan-1-one and 5beta-pregnane-1beta,3alpha,17alpha,20alpha-tetrol. 2. The characterization rested mainly on R(M) analysis of the substances and their derivatives by glycol fission, providing evidence for position and degree of substitution and for steroidal character. Supporting evidence was provided by chemically specific location reactions. 3. Certain problems in the manipulation of these beta-disubstituted steroids are discussed.

Chemical Phenomena