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Biomedical subjects

D Gunnell

Publications and source records attributed to D Gunnell.

65 records · Page 4Linked to original sources
PubMed1997

Non-response bias in a lifestyle survey.

BACKGROUND: Monitoring health targets is often undertaken using questionnaire surveys of lifestyle risk factors. Non-response bias is recognized but rarely quantified. METHODS: Following a questionnaire survey on a random sample of 6009 residents of Somerset with a response rate of 57.6 per cent, a telephone survey was undertaken on a random sample of 400 non-responders. A small number of the more important questions from the questionnaire were put to the non-responders over the phone. RESULTS: Fifty-nine per cent of the sample were contacted and agreed to participate. Statistically significant differences between responders and non-responders to the original questionnaire were detected for current smoking, hazardous alcohol consumption and lack of moderate or vigorous activity. CONCLUSIONS: Lifestyle questionnaire surveys need to include an assessment of the non-response bias.

Adolescent↗
PubMed1997

Finding and using inter-war maternity records.

This paper describes the results of a search for the obstetric records of a cohort of over 5,000 children who participated in surveys of childhood diet and growth during the late 1930s and early 1940s conducted by the Rowett Research Institute in Aberdeen. The surveys were conducted at sixteen centres throughout England and Scotland. Birth-weight data were found in hospitals, health authority archives and local authority record offices for approximately 10 per cent of these children. The sources and methods used to find the records are described and their representativeness is evaluated. It is anticipated that this report will be of some interest to medical historians and epidemiologists conducting retrospective studies.

Body Weight↗
PubMed1997

Suicide by jumping.

This review summarizes the published literature on suicide by jumping, in particular focusing on the social and psychological characteristics of people who have chosen this method of suicide, and the opportunities for prevention. Suicide by jumping accounts for 5% of suicides in England and Wales, and there are marked variations in the use of this method world-wide. A number of locations have gained notoriety as popular places from which to jump. Such sites include The Golden Gate Bridge and Niagara Falls in the USA, and Beachy Head and the Clifton Suspension Bridge in the UK. There is no consistent evidence that those who commit suicide by jumping differ sociodemographically or in their psychopathology from those who use other methods of suicide, although this method is more often used for in-patient suicides, possibly due to lack of access to other means. Survivors of suicidal jumps experience higher subsequent rates of suicide and mental ill health, but the majority do not go on to kill themselves, suggesting that preventive efforts may be worthwhile. This view is supported by other evidence that restricting access to the means of suicide may prevent some would-be suicides. Such measures may also reduce the emotional trauma suffered by those who witness these acts. Health authorities and coroners should consider reviewing local patterns of suicide by jumping, and if necessary institute preventive measures.

Architectural Accessibility↗
PubMed1997

Use of paracetamol for suicide and non-fatal poisoning in the UK and France: are restrictions on availability justified?

OBJECTIVE: To investigate the relationship between the availability of paracetamol and its use for overdose and suicide. DESIGN: Analysis of routinely collected information on time trends for paracetamol suicides, non-fatal overdoses, and sales. SETTING: England and Wales and France. RESULTS: There were strong correlations between trends in paracetamol sales in the UK and trends in non-fatal paracetamol overdose in Oxford between 1976 and 1993 (Spearman's r = 0.86; 95% confidence interval (CI) 0.54, 0.96) and between paracetamol sales and non-fatal overdoses in France between 1974 and 1990 (r = 0.99; 95% CI 0.97, 1.00). Sales figures were also correlated with paracetamol related suicides in both England and Wales, 1983-91 (r = 0.72; 95% CI 0.11, 0.94) and France, 1974-90 (r = 0.79; 95% CI 0.50, 0.92). Similarly strong relationships were observed between trends in non-fatal overdoses and suicide by paracetamol poisoning in England and Wales (r = 0.85; 95% CI 0.61, 0.95) and France (r = 0.79; 95% CI 0.50, 0.92). It is estimated that approximately 32,000 overdoses involving paracetamol occur annually in England and Wales. Fatality rates from paracetamol overdose were four times as high in England and Wales (0.4%, 95% CI 0.38, 0.46) as in France (0.1%, 95% CI 0.06, 0.17). CONCLUSION: Trends towards greater availability of paracetamol are paralleled by increases in its use for both non-fatal overdose and suicide. Paracetamol related morbidity and mortality seem to be less frequent in France where the quantity of paracetamol in a single purchase is limited. Although not conclusive, these data add to a body of evidence which suggests that restrictions in the quantity of paracetamol available as a single purchase in the UK may reduce suicide and liver failure related to paracetamol.

Acetaminophen↗
PubMed1996

Suicide from the Clifton Suspension Bridge in England.

OBJECTIVES: To examine the epidemiology of suicide by jumping from the Clifton Suspension Bridge and its impact on local patterns of suicide. DESIGN: Case-control study of falls from the bridge (1974-93) matched by age and sex with those using other methods of suicide. Routine OPCS mortality statistics for Bristol and District Health Authority. SETTING: The County of Avon and the Bristol and District Health Authority. SUBJECTS: 1. Individuals given coroners' verdicts of suicide, "open", or misadventure after falls from the suspension bridge and 127 matched control suicides using other methods. 2. All deaths from suicide within the Bristol and District Health Authority 1982-91. MAIN OUTCOME MEASURES: Past psychiatric history, demographic characteristics of suicides, and proximity of place of residence to the bridge. RESULTS: There were 127 falls from the Clifton Suspension Bridge between 1974 and 1993. The mean age was 35.4 years for males (n = 93) and 35.5 for females (n = 34). Those who committed suicide by jumping were no more likely to have psychiatric histories than controls (95% CI of difference--1.17%, 23.2%) and were no more likely to have been psychiatric inpatients in the past (95% CI of difference--10.2%, 13.3%). Mean distance of residence from the bridge differed little between jumping suicides and controls (difference 1.7 km 95% CI 0.5, 3.9 km). Altogether 10.2% of jumpers had a past history of schizophrenia. Suicide by jumping is significantly more common in the Bristol and District Health Authority (9.3% of all suicides; 95% CI 7.6%, 11.3%) than in England and Wales (4.9% of suicides). CONCLUSIONS: Patterns of suicide in the Bristol and District Health Authority are affected by the presence of the Clifton Suspension Bridge. Those who commit suicide by jumping from the bridge do not differ significantly from those using other methods of suicide. Provision of safety measures on the bridge may lead to the prevention of some suicides.

Adult↗
PubMed1995

The invasive management of angina: issues for consumers and commissioners.

OBJECTIVE: To review, from the purchaser's perspective, the current state of knowledge of techniques for investigation and treating coronary artery disease. The study was based on evidence from past and continuing randomised controlled trials (RCTs). CRITERIA FOR INCLUSION OF REPORTS: Articles listed on Medline (1990-3) with the keywords coronary disease, angina, and unstable angina (combined with surgery, economics, therapy, or drug therapy) and percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass grafting (CABG) were included. Articles published before 1990 were obtained from two comprehensive literature reviews published by the Rand organisation in 1991 and from the papers obtained using the Medline search. A hand search of relevant journals published between July 1993 and June 1994 was also undertaken. Results from more recently published RCTs are included. RESULTS: CABG provides improved angina relief compared with drug treatment and may prolong life in patients with more severe illness. PTCA is also better than drug treatment, but less so than CABG, and its cost advantages over CABG decrease with time. Repeat intervention for return of symptoms is more frequently required after PTCA, but increasing numbers of patients are also undergoing second and third repeat CABG for graft occlusion in the years after the original operation. Newer PTCA techniques are not, as yet, fully evaluated. One technique, atherectomy, has been shown to be no more effective, and more expensive, than conventional balloon angioplasty. In the short term intracoronary stents reduce the problems associated with vessel occlusion after PTCA and therefore reduce the need for further intervention. PTCA should not be performed without ready access to cardiothoracic support. There is an increasing trend towards the development of coronary catheterisation units at peripheral sites. This may lead to increasing, inappropriate use of this investigation in suboptimal circumstances. CONCLUSIONS: Ischaemic heart disease is an important cause of morbidity and mortality and invasive management techniques are developing rapidly; some service expansion is occurring without trial evidence. More research is required to determine the optimum balance of PTCA, CABG, and angiography and population requirements for these procedures. In the meantime, in the absence of firm long term evidence of the superior cost effectiveness of PTCA compared with CABG, the rapid expansion of this procedure should be limited. Patients should be fully informed of the benefits and disadvantages of CABG and PTCA, where either procedure is indicated, to enable them to make fully informed choices.

Angioplasty, Balloon, Coronary↗
PubMed1994

Prevention of suicide: aspirations and evidence.

The Health of the Nation white paper set a target for 15% reduction in overall suicide rates by the year 2000. If the targets are to be achieved interventions must be identified which are of proved effectiveness. This paper examines the evidence on the available interventions and points of access to the population at risk. No single intervention has been shown in a well conducted randomised controlled trial to reduce suicide. The greatest potential seems to arise from limiting the availability of methods. In particular it is likely that the introduction of the catalytic convertor will lead to reduced lethality of care exhausts and reductions in suicide using this method. General practitioner education programmes, the effectiveness of lithium and maintenance antidepressants, and limits on the quantity of medicines available over the counter or on prescription should all be evaluated. Particular high risk groups include people recently discharged from psychiatric hospitals and those with a history of parasuicide. Many social processes affect suicide rates and these rather than specific interventions may help or hinder the ability to realise the Health of the Nation targets. Well conducted trials are essential to distinguish complex social processes from the effects of specific interventions for suicide prevention. This review of the available evidence offers little support for the aspiration that the posited targets can be achieved on the basis of current knowledge and current policy.

Family Practice↗
PubMed1994

An outbreak of Campylobacter infection associated with the consumption of unpasteurised milk at a large festival in England.

Seventy-two laboratory confirmed cases of Campylobacter infection were identified in people who attended a large festival in England. A case-control study was undertaken to identify the vehicle of infection. Potential risk factors included the water supply to the site, and food, bottled spring water and unpasteurised milk sold at the event. Only the consumption of unpasteurised milk showed a statistical association with having a Campylobacter infection, strongly suggesting that this was the vehicle of infection.

Adolescent↗
PubMed1982

Blockade of central alpha 2-adrenoceptors enhances the carotid occlusion response in dogs.

Intravertebral artery injection of yohimbine at total doses of 10, 50, 100 and 200 micrograms caused dose-related enhancement of the systemic pressor response to bilateral carotid artery occlusion (BCO) in dogs; the response was depressed by 5000 micrograms yohimbine. Basal blood pressure was increased by 100 and 200 micrograms yohimbine, and decreased by 5000 micrograms. Intravertebral artery injection of rauwolscine, 5 micrograms enhanced the BCO response but had no effect on basal blood pressure. Corynanthine, 200 or 500 micrograms was ineffective. The pressor response to intravenously administered noradrenaline was not affected by any of the drugs. It is concluded that enhancement of the BCO response by yohimbine and rauwolscine is caused by blockade of central alpha 2-adrenoceptors.

Adrenergic alpha-Antagonists↗
PubMed1980

alpha 1- and alpha 2-vascular adrenoceptors in the dog.

Prazosin inhibited contractions of isolated electrically stimulated dog pulmonary artery preincubated with (-)-7-3H-norepinephrine, but had no effect on 3H-overflow, whereas yohimbine enhanced both responses. In pithed dogs the cumulative doses of yohimbine required for 50% inhibition of the pressor effects of clonidine, phenylephrine and norepinephrine were 23, 188 and 35 micrograms/kg i.v., and those for prazosin were 9, 1.5 and 5 micrograms/kg i.v., respectively. The agonists could be ranked in pairs depending on the extent to which the antagonists discriminated members of the pair: clonidine-phenylephrine > phenylephrine-norepinephrine > clonidine-norepinephrine. The results suggest that pressor effects in dogs are mediated by both alpha 1- and alpha 2-vascular (i.e. postsynaptic) adrenoceptors.

Animals↗