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Biomedical subjects

R West

Publications and source records attributed to R West.

At least 199 records · Page 11Linked to original sources
PubMed1991

Assessing the functional status during an asthma attack with Dartmouth COOP charts. Validity with respect to the change in asthma.

The functional status of patients was determined during an acute attack of asthma requiring medical intervention. Patients were recruited during two months from general practice: all 28 patients consulting for an acute asthma attack were invited to take part: four refused or were withdrawn from follow up. Matched control patients with asthma, not suffering from an acute attack were selected from the practice file. Patients were investigated directly after the initial intervention and exactly 14 days later: respiratory symptoms, peak expiratory flow rates and functional status were recorded. In all cases the intervention resulted in the relief of symptoms and a return of peak expiratory flow to the normal predicted range for age, sex and height. After the 14 days, patients had no longer evidence of an exacerbation of their asthma. During the attack, there were indications of reduced physical and psychological functions, and reduced daily and social activities. A difference was found in the functional profile of asthmatics with an asthma attack and asthmatics without an asthma attack. After 14 days, the functional status of all the dimensions had improved. There was no evident correlation to the change in functional status and peak expiratory flow rates. An asthma attack hampers the patient in his daily functioning--not only physically, but also in social functioning and feelings. There are indications that the recuperation in terms of functioning takes longer than the symptoms to disappear or the peak expiratory flow to return to normal.(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation, Psychological↗
PubMed1991

The focus and conduct of clinical trials.

This paper discusses some issues regarding how putative stop-smoking treatments should be evaluated. Preliminary evaluations of treatments have used withdrawal symptoms as a surrogate for abstinence in an attempt to decide those treatments on which to carry out expensive full-scale clinical trials. However, withdrawal symptom severity has not been shown to relate to long-term abstinence in any prospective studies. Until a better understanding of the relationship between withdrawal symptoms and abstinence is obtained withdrawal symptoms cannot be considered an appropriate surrogate for abstinence. Research is needed into what pattern of short-term abstinence provides the best predictor of long-term abstinence. Evidence from carbon monoxide validation of short-term abstinence raises doubts about whether minor lapses back to smoking are likely to lead to full blown relapse. Further research into the use of expired-air CO in validation of claims of abstinence is required. Finally, the traditional clinical trials format is not well suited to evaluation of treatment programmes with a large behavioural component. An alternative based on the principles underlying biological evolution is proposed.

Clinical Trials as Topic↗
PubMed1991

Private health insurance and medical care utilization: evidence from the Medicare population.

This paper examines the impact of supplemental health insurance policy ownership on the use of health care services by the elderly. It employs a data base consisting of Medicare claims data from over 2,000 beneficiaries in six states, actual copies of their supplemental insurance policies, and detailed survey information. The results show that policy ownership has a substantial, positive impact on service usage and costs, particularly for beneficiaries in fair or poor health. The greatest impact was found for policies that provide first-dollar coverage.

Aged↗
PubMed1990

Effect of glucose tablets on craving for cigarettes.

Clients attending a smokers clinic were randomly allocated to two groups to assess the effects of glucose tablets in reducing craving for cigarettes. Smokers who had already been abstinent for 1 week were eligible to take part in the study. All subjects completed rating relating to urge to smoke and craving. Then subjects in one group were given packets of dextrose tablets and those in the other group were given packets of tablets containing sorbitol (a low calorie sweetener). Ratings of urges to smoke and craving were taken after 1 week, during which time the subjects had been asked to chew their tablets ad lib. Eight out of ten smokers in each group maintained abstinence. The remaining two smokers either did not abstain or did not turn up for the second measurement session. There was a significant reduction in ratings of urges to smoke and craving in the glucose group compared with the sorbitol group. These results support a theory postulating a link between glucoregulation and cigarette craving. If the results are replicated and it is shown that the reduction in craving translates into improved abstinence rates, oral glucose could be of assistance to smokers wishing to give up.

Female↗
PubMed1990

Incidence of hip fracture in Saskatchewan, Canada, 1976-1985.

The authors ascertained the incidence of hip fracture in Saskatchewan, Canada, residents aged 65 years or older for the 10 years 1976-1985 from computerized hospital discharge records and compared it with rates for several other populations in Northern Europe and the United States. In Saskatchewan, the average annual incidence was 5.5 per 1,000 person-years. The incidence in women was twice that in men, the incidence in urban areas was 27% greater than that in nonurban areas, and there was no secular trend of increasing rates. The incidence of hip fracture in Saskatchewan was lower than that for populations in Scandinavia and the United States but was comparable to rates in English populations. Further study is needed to elucidate the genetic, environmental, and behavioral factors responsible for this variation.

Aged↗
PubMed1990

Alcohol consumption, problem drinking and anti-social behaviour in a sample of college students.

A total of 125 male and 145 female students completed a written questionnaire (response rate 68%) on their consumption levels and patterns, problem drinking and vandalism and assaults associated with drinking, Prevalence of heavy drinking was broadly similar to that found in other college student samples in the UK with 25.6% of male students and 14.5% of female students drinking more than their safe limits of 35 and 21 units per week respectively. Six percent of male and one percent of female students exceeded the problem drinking threshold on the MAST. Twenty percent of the male students and 6% of the females admitted having caused at least some damage to property after having been drinking in the past 12 months. Four percent of males and 5% of females admitted 'minor' assaults. Fifty percent of males and 36% of females had witnessed damage to property and 19% of males and 10% of females had experienced some kind of assault. Vandalism and assaults were positively and independently associated with higher levels of consumption, reasons for drinking and patterns of drinking; in particular morning drinking appeared to play a role. Taking amount of drinking into account, males were more likely to commit acts of vandalism but females were more likely to commit assaults. The results reveal that alcohol-related, anti-social behaviour among students is a significant problem and that, while heavy drinking per se plays a role, other factors are also important.

Adult↗
PubMed1990

Oral tobacco: prevalence, health risks, dependence potential and public policy.

This paper discusses public health policy with regard to oral tobacco use. It notes that in the UK, oral tobacco use is extremely rare. Concern that it might become prevalent among schoolchildren has proved unfounded. Smokeless tobacco almost certainly carries health risks but these risks are probably less than from smoking. What little evidence exists suggests that smokeless tobacco may be less dependence-inducing than cigarettes. In the light of this, the UK Government's decision to ban oral tobacco products is hard to reconcile with their continuing to permit the sale and advertising of cigarettes. A cynic would view the Government's ban as a 'no cost' measure to placate the public health lobby and ease the pressure for more restrictions on cigarette promotion. The inconsistency in the Government's approach to Skoal Bandits and cigarettes may be used as a focus for pressure to change in the laws governing promotion of cigarettes.

Health Policy↗
PubMed1990

Molecular definition of a region of chromosome 21 that causes features of the Down syndrome phenotype.

Down syndrome (DS) is a major cause of mental retardation and heart disease. Although it is usually caused by the presence of an extra chromosome 21, a subset of the diagnostic features may be caused by the presence of only band 21q22. We now present evidence that significantly narrows the chromosomal region responsible for several of the phenotypic features of DS. We report a molecular and cytogenetic analysis of a three-generation family containing four individuals with clinical DS as manifested by the characteristic facial appearance, endocardial cushion defect, mental retardation, and probably dermatoglyphic changes. Autoradiograms of quantitative Southern blots of DNAs from two affected sisters, their carrier father, and a normal control were analyzed after hybridization with two to six unique DNA sequences regionally mapped on chromosome 21. These include cDNA probes for the genes for CuZn-superoxide dismutase (SOD1) mapping in 21q22.1 and for the amyloid precursor protein (APP) mapping in 21q11.2-21.05, in addition to six probes for single-copy sequences: D21S46 in 21q11.2-21.05, D21S47 and SF57 in 21q22.1-22.3, and D21S39, D21S42, and D21S43 in 21q22.3. All sequences located in 21q22.3 were present in three copies in the affected individuals, whereas those located proximal to this region were present in only two copies. In the carrier father, all DNA sequences were present in only two copies. Cytogenetic analysis of affected individuals employing R and G banding of prometaphase preparations combined with in situ hybridization revealed a translocation of the region from very distal 21q22.1 to 21qter to chromosome 4q. Except for a possible phenotypic contribution from the deletion of chromosome band 4q35, these data provide a molecular definition of the minimal region of chromosome 21 which, when duplicated, generates the facial features, heart defect, a component of the mental retardation, and probably several of the dermatoglyphic changes of DS. This region may include parts of bands 21q22.2 and 21q22.3, but it must exclude the genes S0D1 and APP and most of band 21q22.1, specifically the region defined by S0D1, SF57 and D21S47.

Adult↗
PubMed1989

Non-admission or non-invitation? A case-control study of failed admissions.

OBJECTIVE: To examine the causes of non-admission to hospital. DESIGN: Validation of published rates of non-admission by examination of medical records, followed by a case-control study of non-attenders (cases) and attenders (controls). SETTING: General hospital. SUBJECTS: 246 Patients (cases in the case-control study) booked for admissions in four specialties (general surgery, gynaecology, otorhinolaryngology, and trauma and orthopaedics) during April, May, and June 1987 who were not admitted for reasons that seemed to be attributable to the patients. Controls comprised 167 patients admitted to the same specialty on the same day. RESULTS: The validation of administrative records indicated that it is unusual for patients to fail to present for admission without advising the hospital beforehand; this occurred in only 1-3% of all bookings. Information on the circumstances of non-admission and clinical and personal details were collected by means of a six page questionnaire completed by the patients. The case-control study showed that those not admitted were younger and had been on the waiting list longer. Otherwise only small differences were found in the social and clinical characteristics. CONCLUSIONS: Despite a common tendency to blame patients for non-admission, factors due to patients are fairly unimportant.

Age Factors↗
PubMed1989

Non-attendance or non-invitation? A case-control study of failed outpatient appointments.

OBJECTIVE: To determine the causes of non-attendance at new outpatient appointments. DESIGN: Case-control study of non-attenders and attenders. SETTING: Outpatient department of a general hospital. SUBJECTS: All non-attenders (n = 277) for first outpatient appointments in six specialties during a three month period were included. Controls (n = 135) were the attenders who followed every second non-attender; thus they attended the same consultant on the same day that the non-attenders were expected. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Information on the clinical problem, difficulties in attending the hospital, and reasons for non-attendance from the questionnaire were coded and classified. Non-attenders had received shorter notice of their appointment than attenders (14% v 1% had received three days' notice or less). There were small differences in the seriousness of patients' clinical condition. CONCLUSIONS: Client factors are less important than aspects of the service in explaining non-attendance at outpatient appointments.

Adolescent↗
PubMed1989

Time course of cigarette withdrawal symptoms while using nicotine gum.

Ratings of withdrawal symptoms were provided at weekly intervals by 147 smokers clinic clients who managed complete abstinence for 4 weeks. The ratings followed a similar temporal pattern regardless of amount of nicotine gum used. Irritability, depression, difficulty concentrating and restlessness peaked in the 1st week or two and returned to baseline by week 4. Hunger was more persistent. Craving was reported to be the most troublesome withdrawal symptom at first, although by the 4th week hunger was cited almost as often. Across all subjects, evenings were cited most often as the worst time of day for craving but among heavier smokers and those who used more nicotine gum mornings were considered worst.

Female↗
PubMed1989

The Alzheimer amyloid precursor protein maps to human chromosome 21 bands q21.105-q21.05.

The Alzheimer amyloid protein precursor (APP) has previously been localized to human chromosome 21q11.2-q21. We have refined the regional localization to a small region including chromosome bands 21q21.105-q21.05 by using quantitative Southern blot analysis of cell lines aneuploid for parts of chromosome 21. Our findings exclude the APP gene from the minimal region producing the classical phenotypic features of Down syndrome. This further narrowing of the APP location will help in identifying the physical location of the gene causing familial Alzheimer disease.

Amyloid↗
PubMed1989

Relations between reading and musical abilities.

In two studies, groups of children with a wide range of reading ability and including a high proportion of poor readers were given Bentley's musical ability battery. Scores on tonal memory and chord analysis were related significantly to reading age with chronological age and IQ partialled out. The implications of these findings for views about component skills involved in reading and listening to music are discussed.

Auditory Perception↗
PubMed1989

Maternal insecurity and failure to thrive in Asian children.

Four Asian babies were investigated because they failed to thrive. In all four cases the failure to thrive was a result of the mother's social isolation and inability to communicate, and to the father's refusal to accept that there was a problem in the family.

Anxiety↗