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Biomedical subjects

T Richards

Publications and source records attributed to T Richards.

At least 73 records · Page 4Linked to original sources
PubMed1996

Neuroimaging Findings in Anxiety Disorders.

Individuals with severe anxiety have long sought a physical basis for their symptoms. There is increasing evidence to suggest brain abnormalities as the primary mechanism responsible for pathological anxiety, particularly panic disorder. However, older-generation brain imaging techniques, capable of assessing brain structure, have not identified consistent anatomical differences or structural abnormalities by which to explain the symptoms. In this regard, the development of modern functional imaging techniques that can specifically assess regional brain blood flow, metabolic status, or chemical composition are beginning to elucidate underlying brain mechanisms which may be responsible for "state" or situational-specific anxiety and "trait" or pathological anxiety. The intent of this article is to provide a review of neuroimaging studies undertaken to investigate state anxiety or specific anxiety disorders. The focus of this article is on studies that have used newer brain imaging techniques capable of assessing brain functionality, such as single photon emission computerized tomography, positron emission tomography, or magnetic resonance spectroscopy (MRS), in relationship to specific anxiety disorders. We have undertaken studies of panic disorder using MRS to investigate acute panic precipitated by physiological or chemical challanges, such as intravenous sodium lactate infusion, while measuring brain metabolic responses. These studies are presented in detail as a model of how these newer functional imaging modalities can be applied as a tool to begin to unravel the underlying pathophysiological processes responsible for production of panic. It is anticipated that future application of these newer functional imaging techniques will allow both the determination of a brain mechanism(s) responsible for pathological anxiety and advance our understanding of mechanisms responsible for effective treatments.

Journal Article↗
PubMed1995

Effects of reporting methods on infant mortality rate estimates for racial and ethnic subgroups.

Estimation of infant mortality rates for racial and ethnic subgroups has been plagued by uncertainties. Yet policymakers need accurate estimates to allocate resources toward the goal of reducing infant mortality. The authors compared hospital discharge records and death certificate information to birth certificate information from the California Birth Cohort (years 1985-1987) and 1986 Annual Hospital Discharge Abstract. They found discrepancies in infant mortality rates between reporting methods and underreporting of some non-White groups. Infant mortality rates based on death certificates underestimated non-White mortality, particularly for Native Americans and East Asians. Compared to infants who died soon after birth, larger discrepancies in reported race and ethnicity between birth certificates and death certificates for infants who died later also indicated possible errors in hospital reporting methods. These findings extend prior research that documents that standard methods of reporting infant mortality underestimate non-White mortality rates.

Bias↗
PubMed1995

Attitudes and behaviors of African-American and Mexican-American women delivering newborns in inner-city Los Angeles.

To study some of the factors relating to the care of mothers and newborns in an inner-city hospital, three sources of information were reviewed: an obstetric database including information on prenatal care and perinatal mortality, a database of all admissions to the hospital neonatal intensive care unit over the past 5 years, and a detailed questionnaire concerning attitudes and behaviors of recently delivered women. While analyses from these hospital-based data are not conclusive, the results add evidence for the following propositions: 1) Optimal prenatal care is infrequently obtained by mothers delivering at inner-city hospitals. Lack of prenatal care is clearly associated with increased perinatal mortality. While the need for prenatal care is appreciated by 98% of the mothers in this sample, the most frequent reasons why prenatal care is not obtained earlier or more frequently involve knowledge about and access to prenatal care. 2) Inner-city mothers, in general, manifest attitudes and behaviors that promote the welfare of their pregnancies and newborns. These attitudes and behaviors are in stark contrast to those that are frequently attributed to inner-city women by the media. 3) Acute perinatal medical and nursing care are perceived by many postpartum women as suboptimal, particularly in terms of the lack of respect shown to patients by nurses and doctors. 4) Improved acute obstetric and neonatal care improves perinatal morbidity and mortality of infants delivered at inner-city hospitals.

Adult↗
PubMed1994

The Overseas Doctors Training Scheme: failing expectations.

The Overseas Doctors Training Scheme needs appraisal. Set up 10 years ago to improve the quality of postgraduate training that overseas (non-European) doctors receive in Britain, the scheme has been popular, but it is questionable how far it has achieved its aims. If Britain is to continue to employ large numbers of overseas doctors in training grades, both through the scheme and through independent arrangements, the apparent mismatch between their expectations and the reality of what Britain offers must be tackled.

Attitude of Health Personnel↗
PubMed1994

The World Medical Association: can hope triumph over experience?

The World Medical Association was set up in 1947 in the wake of outrage about war crimes committed by doctors in Hitler's Germany. For nearly 50 years it has lurched from one controversy to another, arguing within itself about its funding, its voting system, and the representativeness and political affiliation of some of its member medical associations. The BMA withdrew from the association in 1984, supporting a breakaway "Toronto" group including Canada, the Scandinavian countries, the Netherlands, Ireland, and Jamaica. All but Britain and Jamaica have now rejoined and membership is growing, but the association is still struggling to gain credibility and clout. After 20 years of part time stewardship the recent appointment of a new full time secretary general has fuelled expectations that internal reforms will be implemented, and the WMA's standing and profile improved.

Attitude to Health↗
PubMed1994

Footwear and falls: a case involving new cowboy boots.

We present a case in which footwear contributed to a fall that resulted in a severe closed head injury. The woman in this case was wearing new cowboy-style boots with 1.5-inch heels that placed her ankles at a position of 25 degrees plantar flexion. Each boot heel tapered at a 50 degrees angle at its posterior edge. A steel shank protruded 2.5 in posterior to the metatarsal head, serving as the anterior contact surface in lieu of normal metatarsal contact. The design of the boot plus the fact that she was carrying groceries, reduced her ability to regain her balance after she slipped, and she fell backward, hitting the floor with full force on the occiput. Initial computed tomography scan showed large subdural and epidural hematomas and hemorrhagic contracoup contusions. The patient developed clinical signs and symptoms of secondary brainstem injury, which was later substantiated by magnetic resonance imaging scan.

Accidental Falls↗
PubMed1994

The urge to merge: linking vital statistics records and Medicaid claims.

This paper describes a procedure used to link Medicaid claims data to California vital statistics records for very low birthweight infants. The linkage involved about 53,000 infants born from 1980 to 1987 and 1.46 million claims for delivery/birth-related hospital admissions during the same period. Because the two data files did not share a unique identifier, record linkage required combining evidence across several linking variables: delivery hospital, delivery/birth date or hospitalization period, names, mother's age, and zip code. To combine the various pieces of evidence, we used record linkage theory to compute scores that measure the likelihood of a match, i.e., that two records correspond to the same delivery. These scores appropriately weight the various pieces of evidence for or against a match. Implementation required dealing with large amounts of missing data in one of the files, errors and variations in reported names, and the need to minimize the number of incorrect links. The approach applies to a wide range of linkage problems. The ability to combine existing datasets to form new datasets containing analysis variables from each facilitates analyses that would otherwise be impossible, or prohibitively expensive.

Bias↗