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Biomedical subjects

E Heitman

Publications and source records attributed to E Heitman.

16 recordsLinked to original sources
PubMed2004

Interventions for preventing injuries in problem drinkers.

BACKGROUND: Alcohol consumption has been linked with injuries through motor vehicle crashes, falls, drowning, fires and burns, and violence. In the US, half of the estimated 100,000 deaths attributed to alcohol each year are due to intentional and unintentional injuries. The identification of effective interventions for the reduction of unintentional and intentional injuries due to problem drinking is, therefore, an important public health goal. OBJECTIVES: To assess the effect of interventions for problem drinking on subsequent injury risk. SEARCH STRATEGY: We searched 12 twelve computerized databases: MEDLINE (1966-8/96), EMBASE (1982-1/97), Cochrane Controlled Trials Register (1997, issue #1), PsycINFO (1967-1/97), CINAHL (1982-10/96), ERIC (1966-12/96), Dissertation Abstracts International (1861-11/96), IBSS (1961-1/97), ISTP (1982-1/97) and three specialized transportation databases, using terms for problem drinking combined with terms for controlled trials; bibliographies of relevant trials; and contact with authors and government agencies. The electronic and bibliographic searches were updated in May 2002. SELECTION CRITERIA: Randomized controlled trials of interventions among participants with problem drinking, which are intended to reduce alcohol consumption or to prevent injuries or their antecedents, and which measured injury-related outcomes. DATA COLLECTION AND ANALYSIS: Two authors extracted data on participants, interventions, follow-up, allocation concealment, and outcomes, and independently rated allocation concealment quality. MAIN RESULTS: Of 23 eligible trials identified, 22 had been completed and 17 provided results for relevant outcomes. Completed trials of problem drinkers that compared interventions for problem drinking to no intervention reported reduced motor-vehicle crashes and related injuries, falls, suicide attempts, domestic violence, assaults and child abuse, alcohol-related injuries and injury emergency visits, hospitalizations and deaths. Reductions ranged from 27% to 65%. Because few trials were sufficiently large to assess effects on injuries, individual effect estimates were generally imprecise. We did not combine the results quantitatively because the interventions, patient populations, and outcomes were so diverse. The most commonly evaluated intervention was brief counseling in the clinical setting. This was studied in seven trials, in which injury-related deaths were reduced: relative risk (RR) 0.65; 95% confidence interval (CI) 0.21 to 2.00. However, this reduction may have been due to chance. The majority of trials of brief counseling also showed beneficial effects on diverse non-fatal injury outcomes. REVIEWERS' CONCLUSIONS: Interventions for problem drinking appear to reduce injuries and their antecedents (e.g. falls, motor vehicle crashes, suicide attempts). Because injuries account for much of the morbidity and mortality from problem drinking, larger studies are warranted to evaluate the effect of treating problem drinking on injuries.

Accident Prevention↗
PubMed2000

Interventions for preventing injuries in problem drinkers.

OBJECTIVES: To assess the effect of interventions for problem drinking on subsequent injury risk. SEARCH STRATEGY: Data Sources.- Twelve computerized databases: MEDLINE (1966-8/96), EMBASE (1982-1/97), Cochrane Controlled Trials Register (1997, issue #1), PSYCHINFO (1967-1/97), CINAHL (1982-10/96), ERIC (1966-12/96), Dissertation Abstracts International (1861-11/96), IBSS (1961-1/97), ISTP (1982-1/97) and three specialized transportation databases, using terms for problem drinking combined with terms for controlled trials; bibliographies of relevant trials; and contact with authors and government agencies. SELECTION CRITERIA: Data Selection.- Randomized controlled trials of interventions among particiapnts with problem drinking, which are intended to reduce alcohol consumption or to prevent injuries or their antecedents, and which measured injury-related outcomes. Of 7014 studies identified, 19 (0. 3%) met the inclusion criteria. DATA COLLECTION AND ANALYSIS: Data Extraction.- Two authors extracted data on participants, interventions, follow-up, allocation concealment, and outcomes, and independently rated allocation concealment quality. MAIN RESULTS: Data Synthesis.- In completed trials, interventions for problem drinking were associated with reduced suicide attempts, domestic violence, falls, drinking-related injuries, and injury hospitalizations and deaths, with reductions ranging from 27-65%. Several interventions among convicted drunk drivers reduced motor vehicle crashes and injuries. Because few trials were sufficiently large to assess effects on injuries, individual effect estimates were imprecise. We did not combine the results quantitatively because the interventions, patient populations, and outcomes were so diverse. REVIEWER'S CONCLUSIONS: Conclusion.- Interventions for problem drinking may reduce injuries and their antecedents. Because injuries account for much of the morbidity and mortality from problem drinking, further studies are warranted to evaluate the effect of treating problem drinking on injuries.

Accident Prevention↗
PubMed1999

Social and ethical aspects of in vitro fertilization.

In vitro fertilization (IVF) stands out as one of the contemporary period's most extraordinary technologies, and its social and ethical consequences among the most far reaching. Despite its uncertain effectiveness and medical consequences, IVF has contributed significantly to the medicalization of infertility and the increasingly imperative character of reproductive technology. New developments in IVF, particularly oocyte donation, have created new definitions of treatable infertility and new social needs for IVF; when the technology does not result in pregnancy or healthy babies, these developments have created profound new disappointments. IVF and the commodification of the extracorporeal embryo have also confused the social meaning and legal definition of parenthood. Ultimately the relationship between prospective parents, infertility specialists, and the embryos that they create is a highly ambiguous one. This ambiguity is likely to be a long-term characteristic of efforts to develop, use, and assess assisted reproductive technologies.

Commodification↗
PubMed1998

Ethical issues in technology assessment. Conceptual categories and procedural considerations.

The practice of health care technology assessment involves ethical considerations in all of its varied functions and techniques. Ethical issues in technology assessment can be grouped into the broad categories of normative concepts, diagnosis, prevention and therapy, research and the advancement of knowledge, and allocation of resources. Moreover, the ethics of the assessment process itself must be evaluated in terms of the integrity of the project's goals, procedures, and effects, and evaluators' open and self-critical acknowledgment of their purposes. As a relatively new field, technology assessment can benefit from using a variety of analytic approaches as it works to develop its own methods for evaluating ethical issues related to technology.

Biomedical Research↗
PubMed1998

Tuberculosis in Texas: trends and issues in surveillance.

This study examined, risk factors and trends related to tuberculosis (TB) in Texas from 1987 through 1993. We found a significantly greater incidence of TB among racial/ethnic minorities than among whites. Country of origin, group risk, individual risk, and occupational risk were investigated also. The percentage of affected persons born in either Mexico or Vietnam increased throughout the time of the study. The state-level percentage trends of the individual risk group (alcohol and/or drug abuse) mirrored those of the national level. The most striking observation, however, proved to be the poor quality of data. Drastic yearly differences existed in completion of the "country of origin" field. The fields for "individual risk," "group risk," and "occupational risk" showed completion rates of less than 50%; completeness continued to be a problem in 1997. The poor quality of data diminishes the validity of conclusions about trends in TB in Texas. Recommendations for improving the quality of data are noted.

Adult↗
PubMed1996

The public's role in the evaluation of health care technology. The conflict over ECT.

The use of electroconvulsive therapy (ECT), controversial since its inception, offers an instructive case study on the challenge of addressing patients' perspectives in the evaluation of health care technology. Despite widespread professional acceptance of ECT, groups of former psychiatric patients have worked through the U.S. legal system to restrict and even ban ECT in the treatment of mental illness. This unusual lay participation in the regulation of health care illustrates how differing conceptions of evidence can affect the evaluation of technology. ECT provides a powerful example of the value of a more complex definition of the significant outcomes of treatment and the growing practice of outcomes assessment, especially as such research is used to shape health policy.

Brain Diseases↗
PubMed1993

Creating a course on ethics in the biological sciences.

The authors examine the social and scientific context within which a course on the ethical dimensions of the biological sciences was created in the mid-1980s to instruct students at The University of Texas-Houston Health Science Center's Graduate School of Biomedical Sciences. They discuss how the basic purposes of such a course--to help students resolve ethical issues encountered in the scientific work, examine the values underlying science, and explore its relation and obligations to society--may be accomplished, and describe the salience to scientific work of two ethical values significant for science, truthfulness and benefit to others, to demonstrate the application of ethics to science. The present version of the course is described. Particular issues arising in the construction of a course on ethics and science are described, such as gaining faculty support, selecting instructors, constructing a syllabus of topics, using cases in instruction, creating examinations dealing with students from other cultures who may have difficulty with applying and using American values, and evaluating the educational effort.

Biological Science Disciplines↗
PubMedDate not supplied

Preventing injuries through interventions for problem drinking: a systematic review of randomized controlled trials.

To assess the effect of treatment of problem drinking on injury risk, we conducted a systematic review of randomized controlled trials by searching 12 computerized databases, cross-checking bibliographies, and contacting authors and governmental agencies. We identified 19 trials of interventions for problem drinking that measured injury outcomes. Treatment for problem drinking was associated with reduced suicide attempts, domestic violence, falls, drinking-related injuries, and injury hospitalizations and deaths, with reductions ranging from 27 to 65%. Interventions among convicted drunk drivers reduced motor vehicle crashes and injuries. The precision of all the point estimates was low, however. We did not combine the results quantitatively, because the interventions, patient populations, and outcomes were so heterogeneous. The results suggest that treatment for problem drinking may reduce injuries and their antecedents. Because injuries account for much of the morbidity and mortality from problem drinking, further studies are warranted to confirm these effects.

Alcoholism↗