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Biomedical subjects

R West

Publications and source records attributed to R West.

At least 145 records · Page 8Linked to original sources
PubMed1997

What happens to anxiety levels on giving up smoking?

OBJECTIVE: DSM-IV lists increased anxiety as a nicotine withdrawal symptom. Increased anxiety has been reported to follow smoking cessation in most but not all studies. Indeed, there is some evidence for a reduction in anxiety, compared with precessation levels, after the first few weeks of abstinence. This study reports data from 101 smokers who attempted to stop smoking and who satisfied DSM-III-R criteria for nicotine dependence. METHOD: Unlike most studies in this area, a strict criterion of lapse-free abstinence was adopted. It is argued that lapses during an attempt at cessation may underlie a transient increase in anxiety. Anxiety was measured both by a single rating typical in withdrawal studies and by the State-Trait Anxiety Inventory--State Form X. Patients were rated 2 weeks and 1 week before cessation, immediately before cessation, 24 hours after cessation, and 1, 2, 3, and 4 weeks after cessation. RESULTS: Seventy patients were abstinent for the 4-week follow-up period. There was no evidence of an increase in anxiety following smoking cessation. However, there was a significant decrease in anxiety from the first week of abstinence. CONCLUSIONS: The results weaken the view that increased anxiety is a robust and central element of the nicotine withdrawal syndrome and suggest that giving up smoking is quite rapidly followed by a reduction in anxiety that may reflect removal of an anxiogenic agent, nicotine.

Adolescent↗
PubMed1997

Addiction, ethics and public policy.

Addiction affects the lives of all of human kind, either directly or indirectly. The cost to individuals and societies is immense and tackling the problem is as much one for policy makers as clinicians, counsellors and scientists. Ethical issues permeate much of the work of all these groups. The issue of what is right and wrong, morally defensible or morally unacceptable arises at both an individual and societal level. This special issue contains 21 commissioned articles from leading figures in addiction research. To set the scene for these in-depth analyses, this article reports the results of an expert panel survey on addiction, ethics and public policy. A total of 199 people from 24 countries identified as first authors of research papers abstracted in Addiction Abstracts in 1994 and 1995 completed a postal questionnaire asking their views on a range of issues. They were asked to state their position on the issue and to identify what they considered to be the most important factors in the decision. Among the findings of interest were: a majority believed that possession of cannabis should be legal but that possession of 'hard drugs' should be illegal. An overwhelming majority believed that tobacco advertising should be banned, that smoking should be prohibited in public buildings and offices and that the legal age for tobacco sales should be 18 or more. A majority believed that researchers should not accept backing from tobacco companies; opinion on accepting backing from the alcohol industry was more evenly divided. An overwhelming majority believed that drug addicts should be able to attend treatment centres on demand and that some form of methadone maintenance should be available to addicts who want it. The survey should prove a useful resource when debating the issues in policy and research arenas.

Attitude to Health↗
PubMed1996

The role of magnetic resonance imaging in the diagnosis of Alzheimer disease in adults with Down syndrome.

OBJECTIVE: To correlate findings from magnetic resonance imaging (MRI) with neuropathological analysis and clinical assessment of Alzheimer disease in patients with Down syndrome. DESIGN AND METHODS: Case study of 1 elderly man with trisomy 21 and Alzheimer disease who had been followed up prospectively over a 5-year period. The patient was a resident in a supervised community unit and died with end-stage dementia. The MRI changes were correlated with the results of clinical psychopathological analysis and neuropathological brain tissue findings. To our knowledge, this is the first case in which clinical, MRI, and neuropathological data were available in a case involving an elderly patient with Down syndrome and Alzheimer disease. RESULTS: The MRI findings correlated with the clinical deterioration and neuropathological features of Alzheimer disease. Marked changes in temporal and hippocampal regions were found. CONCLUSION: Magnetic resonance imaging is potentially a valuable tool in the diagnosis of Alzheimer disease in adults with Down syndrome, particularly in individuals for whom standard intellectual assessments are not possible.

Aged↗
PubMed1996

Randomised controlled trial of ondansetron in smoking cessation.

A double-blind, placebo controlled trial was undertaken to examine the effect of the 5-HT3 antagonist, ondansetron .25 mg bd on cigarette withdrawal symptoms and on proportion of individuals maintaining continuous abstinence for 4 weeks in a smoking treatment programme. A total of 111 smokers were allocated to active or placebo conditions and began taking their study medication 2 weeks before the quit date. They attended the smokers clinic for weekly group treatment sessions. The results showed no evidence for less severe withdrawal symptoms or improved abstinence rates in the active medication group. They suggest that inhibiting 5-HT3 activity is not an effective method of controlling nicotine withdrawal or helping smokers to stop.

Adolescent↗
PubMed1996

Cigarette smoking and psychophysiological stress responsiveness: effects of recent smoking and temporary abstinence.

Studies comparing the cardiovascular function and stress responsiveness of regular smokers and non-smokers have produced mixed results, possibly because of variable intervals between stress tests and recency of smoking. This experiment compared the cardiovascular, cortisol and affective responses to a problem solving task of non-smoking young men (n = 16) and regular smokers randomised to overnight abstinence (n = 14) and smoking 30 min prior to testing (n = 19). Smoking status was validated biochemically. Overnight abstinence was associated with reduced diastolic blood pressure at rest and with enhanced diastolic pressure and emotional responses to the task compared with other conditions. Recent smokers showed elevated heart rates, suppressed cardiac baroreceptor reflex sensitivity and reduced cortisol responsiveness, but did not differ from non-smokers in blood pressure responses. The behavioral performance of the abstinent group was impaired, and their craving was greater than that of recent smokers. Both groups of smokers reported more dysphoric mood than non-smokers, and showed only limited recovery of emotional equilibrium following tests. The results are discussed in relation to mechanisms linking smoking, stress responsiveness and cardiovascular disease risk. The methodological implications for including regular smokers in psychophysiological studies are also considered.

Adult↗
PubMed1996

Role of formal instruction and informal practice in learning to drive.

Learning to drive a motor vehicle is important for the mobility of the majority of people in industrialized countries. Although a great deal is known about the acquisition of psychomotor skills in the laboratory and in some other practical settings, there has been little scientific study of learning to drive. One major practical question concerns the value of formal tuition with a qualified instructor and informal practice with friends or relatives. This paper reports a cross-sectional study of 805 learner drivers in the UK who had undergone at least 5 h of formal tuition to examine associations between their history of formal tuition and practice and current levels of skill and confidence as assessed by both pupils and their instructors. The results indicated an increase in instructor ratings of pupil skill with both increasing practice and tuition. However, the relationship between tuition and instructor-rated skill was only observed in pupils who had had no practice. Pupils' self-confidence did not increase with either tuition or practice; instructors' feelings of confidence in and safety with the pupil increased with pupils' prior hours of practice but not tuition. Instructors' ratings of the likelihood that pupils would pass the driving test first time were positively associated with prior hours of practice and negatively associated with prior formal tuition. The results suggest that informal practice constitutes an important element of the process of learning to drive. Longitudinal and experimental studies are now required to confirm this finding and to establish whether recommendations should be made for a component of driving tuition involving supervised practice.

Adolescent↗
PubMed1996

Clinical spectrum, investigations and treatment of Budd-Chiari syndrome.

The clinical presentation, investigations, therapeutic modalities, prognosis and outcome of 44 patients with Budd-Chiari syndrome (BCS) were reviewed. There were 27 women and 17 men. Median age at presentation was 37 years (range 14-60). Possible aetiological factors were identified in 31 patients (70%). Myeloproliferative disorders were the commonest aetiology. Abdominal pain and swelling were the commonest presenting symptoms. Sixteen patients underwent a shunt operation (14 mesocaval, 2 mesoatrial). Ten patients had liver transplantation. Eleven patients had angioplasty/stent as their only treatment, and seven were treated medically or died before any treatment was instituted. Radiological intervention was comparable to mesocaval shunt in relieving patients' symptoms and in achieving good long-term results. Medical treatment and liver transplantation both yielded poor results. Radiological intervention in the form of balloon angioplasty or stent placement gives good results in a subgroup of BCS patients, and should be tried first to relieve the hepatic outflow obstruction. Mesocaval shunts provide good results in selected cases. Underlying haematological causes should be intensively investigated and promptly treated.

Adult↗
PubMed1996

Commercial logging fatalities in Ontario, 1986-1991.

Despite the economic importance and hazardous nature of commercial logging in various regions, few medical studies have examined fatalities in this industry. Data derived from the files of the Ontario Chief Coroner's Office revealed 52 deaths, all men, from 1986 to 1991 in the province of Ontario. Forty-four cases were accidents (age range 20-73 years; average, 44 years), the majority involving experienced loggers. Personal error resulting in preventable unsafe work practices was a factor in most accidents (n = 35; 79.5%). Almost one half of injured workers were struck by either dead or cut trees. Although the majority of cases occurred in remote areas, delayed medical attention as a factor contributing to death was uncommon. Many of the injuries were nonsurvivable and most victims (n = 33; 75%) were dead at the scene. Most deaths were caused by either head and neck injuries (n = 20; 45.5%), multiple trauma (n = 10; 23%), chest trauma only (n = 6; 13.5%), or mechanical asphyxia (n = 5; 11%). Blood alcohol was negative in 24 accident victims tested. Eight deaths (age range 42-52 years; average, 49 years) were due to cardiac causes, mainly ischemic heart disease. Disease may have contributed to two accidents.

Abdominal Injuries↗
PubMed1996

Nursing the spirit.

Explore the source record for details and available documents.

Attitude to Death↗
PubMed1995

With nurse practitioners, who needs house officers?

The boundaries between the work of doctors and that of nurses are changing, with nurses taking over important parts of junior hospital doctors' clinical work. In 1993 an exploratory study was carried out to identify the professional, educational, and management issues that such developments raise. Interviews were carried out with a range of stakeholders in three innovatory posts in which nurses were doing much of the clinical work of house officers. A complex picture of perceived benefits and problems for patients, junior doctors, and nurses emerged. These seemed to be associated with (a) the extent to which the contribution of professional nursing was valued in the new role and (b) the amount of clinical discretion which the postholder was allowed, this depending on the type of preparatory education provided and the management of the post. The study points to the need for strategic issues--such as the development of appropriate education and the professional recognition of these new clinical roles--to be addressed at a national and regional level.

Humans↗
PubMed1995

Behavioural characteristics and involvement in different types of traffic accident.

Recent research has shown risk of road traffic accident involvement to be associated with the tendency to commit driving violations, fast driving, and a lack of thoroughness in decision making. It has also been shown that three broad types of accident can be used to categorise more than 70% of drivers' brief written descriptions of their accidents. These categories are "shunts" (rear-end collisions), right-of-way violations, and loss-of-control accidents. Furthermore, for each accident type the role of the reporting driver may be defined as active (striking) or passive (struck) depending on the position of his/her vehicle. This paper reports two studies examining the extent to which measures of tendency to commit violations (measured by the Driver Behaviour Questionnaire (DBQ)), frequency of fast driving (measured by the Driving Style Questionnaire (DSQ)) and thoroughness in decision making (measured by the Decision Making Questionnaire (DMQ)) are associated specifically with involvement in each of the main accident types. The results showed that a high DBQ-violation score was associated with accidents in general, both active and passive, and specifically with active loss-of-control accidents and passive right-of-way accidents. High DSQ-speed and low DMQ-thoroughness were associated with active but not passive accidents, high DSQ-speed with active right-of-way violations, and low DMQ-thoroughness was specifically associated with active shunts and active right-of-way violations. The implications of these results are discussed.

Accidents, Traffic↗