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Biomedical subjects

J N Edwards

Publications and source records attributed to J N Edwards.

At least 19 recordsLinked to original sources
PubMed1996

Chronic stress and psychological well-being: evidence from Thailand on household crowding.

This paper examines the effect of one form of chronic stress--household crowding--on psychological well-being, as measured by multiple inverse indicators of psychological well-being. We rely on data from a large (n = 2017) random sample of households in Bangkok, Thailand, a context that has a higher level and broader range of crowding than typically found in the United States. Objective household crowding is found to be detrimental to psychological well-being, controlling for a number of background characteristics. The effect of objective crowding is mediated by subjective crowding, which has strong, consistent and direct detrimental effects on well-being. There is no evidence of a gender effect. Extended family households are not uncommon in Bangkok, but the effects of objective and subjective crowding are similar in both two- and three-generation households, as well as in one- and multiple-couple households. The argument that subjective crowding is an effect, rather than a cause, of psychological well-being is examined and rejected. The findings suggest that crowding, as a chronic source of stress, constitutes a major threat to psychological well-being. Although the empirical analyses are based on data from one city, we frame the issue of household crowding in a historical and theoretical context in order to suggest in which cultural settings household crowding is most likely to have detrimental effects on psychological well-being.

Adaptation, Psychological↗
PubMed1996

Physician response to patient insurance status in ambulatory care clinical decision-making. Implications for quality of care.

OBJECTIVES: Individuals without health insurance in general receive fewer health services and are more likely than insured patients to experience poor outcomes. The main goal of this research was to study whether physicians' clinical recommendations vary for insured and uninsured patients, implying that physicians' choices of care may mediate insurance-related differences in health care use. METHODS: The authors designed clinical scenarios that describe routine decisions encountered by primary care physicians in ambulatory settings. Scenarios were designed to include discretionary, nondiscretionary, preventive, and diagnostic/therapeutic services. Insurance status of patients was indicated as either insured or uninsured for the service under consideration. Scenarios were presented to a nationally representative sample of primary care physicians (n = 1182) as part of the American Medical Association 1992 Socio-economic Monitoring System Survey. Physicians were assigned randomly to receive eight scenarios in which patients were either insured or uninsured. For each scenario, physicians were asked to indicate the percentage of patients for whom they would recommend a given service. RESULTS: After controlling for variables associated with nonresponse, we found that physicians who were presented scenarios with insured patients recommended service for 72% of patients, and physicians who were presented scenarios with uninsured patients recommended the same services for 67% of patients (P < 0.001). Physicians recommended both discretionary services (50% versus 42%; P < 0.001) and nondiscretionary services more often for insured than uninsured patients (93% versus 91%; P < 0.05). CONCLUSIONS: In self-reports, physicians are more likely to recommend services for insured than for uninsured patients, and more so when services are discretionary. This provides evidence that physicians' recommendations may be important mediators of insurance-related variation in the use of health-care services. Higher rates of use among the insured may not always reflect higher quality of care, particularly when the service is discretionary in nature.

Adult↗
PubMed1994

Time to discontinue the use of solutions A and B as a cyanide 'antidote'.

Solutions A and B (15.8% ferrous sulfate in 0.3% citric acid and 6% sodium carbonate, respectively) have been available as a first-aid treatment for cyanide ingestion for many decades. Controversy surrounding the efficacy of solutions A and B has existed for much of that time, the main protagonists being in the UK. The current opinion in the UK is that solutions A and B should no longer be used as a first-aid measure in the management of cyanide poisoning. Similarly, oral sodium thiosulfate or activated charcoal should not be used. The recommended first-aid treatment of symptomatic cyanide poisoning is 100% oxygen and amyl nitrite, irrespective of the route of exposure.

Antidotes↗
PubMed1993

Housing, stress, and physical well-being: evidence from Thailand.

The proposition that poor housing and congested living conditions have a detrimental impact on health has been promulgated for at least 150 years. At a minimum, two major causal mechanisms are thought to be involved in the relationship between crowding and physical health. First, high levels of household crowding can produce stress that leads to illness. Second, through shared physical proximity, household congestion contributes to the spread of communicable disease. The outcomes can be exacerbated by poor quality housing. A significant body of research, conducted primarily in affluent countries, has documented the detrimental effects of housing conditions on a variety of illnesses, including various contagious diseases. Poor housing has even been linked to high infant and adult mortality rates. The view that poor housing conditions and household crowding inevitably leads to poor health is challenged, however, by several observers, who question the role played by both crowding and housing quality. Most existing research has been conducted in affluent countries. Little is known, however, about the nature of these relationships within the context of less developed countries, where health status and housing quality are generally much poorer and where levels of household crowding are generally higher. Determination of the effects, if any, of housing quality--including household crowding--on physical health in developing countries is particularly important given the rapid growth of their urban populations and the difficulty of increasing the physical infrastructure fast enough to keep pace with this growth. This paper reports on an investigation of the impact of housing conditions and household crowding in the context of one developing country, Thailand. Using data from a representative sample of households in Bangkok (N = 2017), our results provide reason for some skepticism regarding the influence on housing on health, at least in its objective dimensions. While the skepticism of some is based on a reading of the evidence in Western countries, we likewise find that, in Bangkok, objective indicators of housing quality and household crowding are little related to health. We do find, however, that subjective aspects of housing and of crowding, especially housing satisfaction and a felt lack of privacy, have detrimental effects on health. Furthermore, psychological distress is shown to have a potent influence on the physical health of Bangkokians. Our analyses suggest that all three factors have independent effects on health outcomes bearing on both men and women.

Adult↗
PubMed1993

Congenital pseudarthrosis of the clavicle.

Congenital pseudarthrosis of the clavicle is a rare anomaly in which the clavicle is formed in utero in two separate segments. Clinically, there is a bump and a palpable discontinuity at the middle of the clavicle. There is no swelling or tenderness, nor disability. Radiologically, the medial ends of both clavicular segments are blunt and there is no interruption of cortical bone. The differential diagnosis includes birth fracture of the clavicle and craniocleidal dysostosis. The obstetrician should be aware of this condition as, if it is misdiagnosed, he may be wrongly accused of birth fracture.

Clavicle↗
PubMed1993

Gender and health: some Asian evidence.

In Thailand, like the U.S., women's higher rates of illness and health service use imply that they are "sicker." But, as in the U.S., females live longer than males. Based on a large representative sample of Bangkokians, we find that married women report more sickness, are more likely to utilize health services and, according to self-reports, have poorer health. Western literature suggests five prominent explanations for gender differences in health: biological risks, acquired risks, psychosocial aspects of symptoms and care, health-reporting behavior, and prior health care and caretakers. However, analyses show that these explanations largely fail to account for morbidity differences between Thai men and women. The observed gender differences in health among Thais remain significant after eliminating pregnant women and new mothers, and after controlling for several aspects of acquired risk. Problems associated with the reproductive system among Thai women, along with greater psychological distress, appear to account for most of the gender differences in health. The theoretical implications of these findings are discussed. As for the apparent contradiction between gender differences in health and mortality in Thailand, the evidence indicates that Thai men, like their American counterparts, suffer from more serious chronic ailments that may explain their higher mortality rates.

Adult↗
PubMed1991

Comparison of patient-controlled and nurse-controlled antiemetic therapy in patients receiving chemotherapy.

The purpose of this quasi-experimental pilot study was to compare the effect of patient-controlled (PCAE) and nurse administered (NCAE) antiemetic therapy for controlling chemotherapy-induced nausea and vomiting in patients receiving moderate emetogenic chemotherapy. Twenty subjects were randomly assigned to either the PCAE group who received IV antiemetic medication via a patient-controlled pump or the NCAE group who received antiemetic medication via nurse administered minibags. Nausea, vomiting, sedation, and drug consumption were measured. There was no difference in nausea scores between the two groups. Subjects in the PCAE group consumed significantly less medication than subjects in the NCAE group.

Adult↗
PubMed1986

The social demography of shared housing.

"Despite the prevalence of shared housing in Australia, almost one-third of all households, little is known about who are the people who share accommodation, and why they do so. Using a sample of 4,560 households, this paper presents a demographic profile of shared dwellings and tests some of the prevailing assumptions about why certain groups may have a propensity to share. Some of the implications of the findings for existing housing policies are pointed out and directions for future research are suggested."

Australia↗
PubMed1986

Divorce and marital instability over the life course.

"This study uses a [U.S.] national sample of married persons under age 55, interviewed in 1980 and again in 1983, to estimate why divorce and marital instability vary by age and duration of marriage. Results indicate that the accumulation of assets substantially reduces the propensity to divorce. We also find that several important correlates of divorce and instability (age at marriage, health, social integration, and income) interact with age and duration. In general, these factors seem to operate almost exclusively among young people and young marriages."

Age Factors↗
PubMed1986

Amniotic fluid infection syndrome and abruptio placentae.

The incidence of amniotic fluid infection syndrome, as assessed by the presence of an acute inflammatory infiltrate of the placenta, umbilical cord, and membranes at birth, was 23.3% in pregnancies complicated by severe abruptio placentae. This was not significantly higher than that noted in uncomplicated pregnancies. These data therefore fail to support the proposal that amniotic fluid infection predisposes to placental abruption.

Abruptio Placentae↗
PubMed1985

Langerhans' cells and lymphocyte subsets in the female genital tract.

Cryostat sections of healthy cervical, vaginal and vulval epithelium were examined using immunohistological labelling techniques and a panel of monoclonal antibodies recognizing Langerhans' cells, T- and B-lymphocytes and HLA-DR antigen. The distribution of Langerhans' cells in squamous epithelium of the cervix, vagina and vulva showed a marked variation with the highest median values in the vulva (18.7 per 100 basal squamous cells) and the lowest in the vagina (5.5 per 100 basal squamous cells). There was also a substantial variation in number and distribution of lymphocytes of each of these three areas with a distinct preponderance in the transformation zone of the cervix. In addition, intraepithelial lymphocytes, predominantly of the T-cytotoxic suppressor sub-type were present at all sites with the greatest number in the transformation zone. We conclude from this study that lymphoid tissue of the cervical transformation zone has several unique characteristics which are not observed at other sites in the lower genital tract. We suggest that this tissue be designated 'cervical lymphoid tissue' and that it forms a part of the 'mucosal associated lymphoid tissue' (MALT) as noted at other mucosal sites exposed to the external environment.

Adult↗