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Biomedical subjects

K Graham

Publications and source records attributed to K Graham.

At least 37 records · Page 2Linked to original sources
PubMed2000

Results of a pilot program for training bar staff in preventing aggression.

One hundred and twenty-one staff from eight bars in Ontario, Canada participated in a three-hour training program that used a peer learning model to teach problem-solving skills regarding the prevention and management of aggressive behavior in bars. Participants showed significant positive changes in knowledge and attitudes regarding effective approaches to preventing aggression. The majority of participants reported that the training made them think about ways they handed problem situations and that they would change the way they handle problems in the future. Participants rated most aspects of the training as very useful, especially the group discussion. The program illustrates the potential for increasing skills and knowledge of bar staff in preventing aggression and associated injury.

Adult↗
PubMed2000

Introduction: community action research and the prevention of alcohol problems at the local level.

Many community action projects from around the world exist to reduce alcohol problems at the local level. The role of research within this international movement is discussed within this introduction for the entire special issue on community action research in alcohol problem prevention. Previous community prevention programs have utilized a variety of prevention strategies: (a) an educational approach which focuses on changing behavior through changes in knowledge, attitudes, and information; and (b) an environmental approach which focuses on changing behavior through changes in the social and economic systems within a community. Many projects have used both approaches. This special issue provides a current overview of many types of community action projects from different countries and summarizes what has been learned to date from these experiences.

Alcoholism↗
PubMed2000

Community action research: who does what to whom and why? Lessons learned from local prevention efforts (international experiences).

This paper describes lessons learned about community action research, drawing upon papers written and presented at a recent international conference on community action research and the prevention of alcohol and other drug problems. Projects reflected both action and evaluation research traditions and focused on a variety of issues from moderation of drinking to alcohol-related violence, and on range of target populations from youth to specific ethnic groups. The interventions described ranged from policy-based prevention to education and training and to secondary prevention and treatment. Lessons identified in the papers are discussed within three broad areas: the community targeted for change; the implementation of community projects; and community action research projects generally. The common lessons emerging from these diverse projects provide useful lessons on which to base future progress in community action research.

Alcoholism↗
PubMed1999

Role of the myxoma virus soluble CC-chemokine inhibitor glycoprotein, M-T1, during myxoma virus pathogenesis.

Myxoma virus is a poxvirus that causes a virulent systemic disease called myxomatosis in European rabbits. Like many poxviruses, myxoma virus encodes a variety of secreted proteins that subvert the antiviral activities of host cytokines. It was recently demonstrated that the myxoma virus M-T1 glycoprotein is a member of a large poxvirus family of secreted proteins that bind CC-chemokines and inhibit their chemoattractant activities in vitro. To determine the biological role of M-T1 in contributing to myxoma virus virulence, we constructed a recombinant M-T1-deletion mutant virus that was defective in M-T1 expression. Here, we demonstrate that M-T1 is expressed continuously during the course of myxoma virus infection as a highly stable 43-kDa glycoprotein and is dispensable for virus replication in vitro. Deletion of M-T1 had no significant effects on disease progression or in the overall mortality rate of infected European rabbits but heightened the localized cellular inflammation in primary tissue sites during the initial 2 to 3 days of infection. In the absence of M-T1 expression, deep dermal tissues surrounding the primary site of virus inoculation showed a dramatic increase in infiltrating leukocytes, particularly monocytes/macrophages, but these phagocytes remained relatively ineffective at clearing virus infection, likely due to the concerted properties of other secreted myxoma virus proteins. We conclude that M-T1 inhibits the chemotactic signals required for the influx of monocytes/macrophages during the acute-phase response of myxoma virus infection in vivo, as predicted by its ability to bind and inhibit CC-chemokines in vitro.

Animals↗
PubMed1999

Efficacy and safety of lovastatin in adolescent males with heterozygous familial hypercholesterolemia: a randomized controlled trial.

CONTEXT: Heterozygous familial hypercholesterolemia (HeFH) is a common disorder associated with early coronary artery disease, especially in men. The age at which drug therapy should be started is still controversial, as is the use of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins). OBJECTIVE: To assess the lipid-lowering efficacy, biochemical safety, and effect on growth and sexual development of lovastatin in adolescent boys with HeFH. DESIGN: One-year, double-blind, placebo-controlled, balanced, 2-period, 2-arm randomized trial. In the first period (24 weeks), lovastatin was increased at 8 and 16 weeks and the dosage remained stable during the second period (24 weeks). The study was conducted between 1990 and 1994. SETTING: Fourteen pediatric outpatient clinics in the United States and Finland. PATIENTS: Boys aged 10 to 17 years with HeFH. Of 132 randomized subjects (67 intervention, 65 placebo), 122 (63 intervention, 59 placebo) and 110 (61 intervention, 49 placebo) completed the first and second periods, respectively. INTERVENTION: Lovastatin, starting at 10 mg/d, with a forced titration at 8 and 16 weeks to 20 and 40 mg/d, respectively, or placebo. MAIN OUTCOME MEASURES: The primary efficacy outcome measure was low-density lipoprotein cholesterol (LDL-C). Primary safety measures were growth and sexual development. RESULTS: Compared with placebo, LDL-C levels of patients receiving lovastatin decreased significantly (P<.001) by 17%, 24%, and 27% receiving dosages of 10, 20, and 40 mg/d, respectively, and remained 25 % lower than baseline at 48 weeks. Growth and sexual maturation assessed by Tanner staging and testicular volume were not significantly different between the lovastatin and placebo groups at 24 weeks (P = .85) and 48 weeks (P = .33); neither were serum hormone levels or biochemical parameters of nutrition. However, the study was underpowered to detect significant differences in safety parameters. Serum vitamin E levels were reduced with lovastatin treatment consistent with reductions in LDL-C, the major carrier of vitamin E in the circulation. CONCLUSIONS: This study in adolescent boys with HeFH confirmed the LDL-C-reducing effectiveness of lovastatin. Comprehensive clinical and biochemical data on growth, hormonal, and nutritional status indicated no significant differences between lovastatin and placebo over 48 weeks, although further study is required.

Adolescent↗
PubMed1999

Long-term blood cholesterol-lowering effects of a dietary fiber supplement.

BACKGROUND: The study evaluated the blood cholesterol-lowering effects of a dietary supplement of water-soluble fibers (guar gum, pectin) and mostly non-water-soluble fibers (soy fiber, pea fiber, corn bran) in subjects with mild to moderate hypercholesterolemia (LDL cholesterol, 3.37-4.92 mmol/L). METHODS: After stabilization for 9 weeks on a National Cholesterol Education Program Step 1 Diet, subjects were randomly assigned to receive 20 g/d of the fiber supplement (n = 87) or matching placebo (n = 82) for 15 weeks and then receive the fiber supplement for 36 weeks. The efficacy analyses included the 125 subjects (58 fiber; 67 placebo) who were treatment and diet compliant. One hundred two (52 fiber; 50 placebo) completed the 15-week comparative phase. Of these subjects 85 (45 fiber; 40 placebo) elected to continue in the 36-week noncomparative extension phase. RESULTS: The mean decreases during the 15-week period for LDL cholesterol (LDL-C), total cholesterol (TC), and LDL-C/HDL-C ratio were greater (P < 0.001) in the fiber group. The mean changes from pre-treatment values in LDL-C, TC, and LDL-C/HDL-C ratio for subjects in the fiber group were -0.51 mmol/L (-12.1%), -0.53 mmol/L (-8.5%), and -0.30 (-9.4%), respectively. The corresponding changes in the placebo group were -0.05 mmol/L (-1.3%), -0.05 mmol/L (-0.8%), and 0.05 (1.5%), respectively. The fiber supplement had no significant effects (P > 0.05) on HDL cholesterol (HDL-C), triglyceride, iron, ferritin, or vitamin A or E levels. Similar effects were seen over the subsequent 36-week noncomparative part of the study. CONCLUSIONS: The fiber supplement provided significant and sustained reductions in LDL-C without reducing HDL-C or increasing triglycerides over the 51-week treatment period.

Adolescent↗
PubMed1999

The effect of botulinum toxin A on gastrocnemius length: magnitude and duration of response.

Thirty-nine ambulant children (22 with hemiplegia, 17 with diplegia) with spastic cerebral palsy receiving isolated gastrocnemius muscle injection with botulinum toxin A were studied prospectively. The children had a mean age of 6 years (range 3 to 13 years). Measurement of gastrocnemius muscle length was used to estimate the dynamic component of each child's spasticity and to quantify the response. There was a strong correlation between the dynamic component of spasticity before injection and the corresponding magnitude of the response after injection. Children undergoing repeated injections showed similar correlations. A strong correlation was found between the duration of response and the dynamic component. Children with hemiplegia showed twice the duration for a given dynamic component compared with those with diplegia when injected with the same total dose per unit body weight. Long-term lengthening did not occur for the cohort, although some patients showed a response at a 12-month follow-up. By delaying shortening, the injections may have a role in delaying the need for surgery. Injections were well tolerated with few side effects.

Adolescent↗
PubMed1999

High- or low- technology measurements of energy expenditure in clinical gait analysis?

The repeatability of energy-expenditure measurements were studied in five children and four adults without disabilities using the Cosmed K4 (high technology). The ability to detect change in measurements was compared between this instrument and the Physiological Cost Index (PCI; low technology). The results of repeatability (95% range) for oxygen cost were 13.1% in children and 13% in adults. In contrast, the SD of PCI was 6 to 72% of the mean in adults and wider in children (91%; 95% range). The validity of PCI as an outcome measure was questioned. In addition, 177 children with motor disability were prospectively studied using the Cosmed K4. Previous experience with the Cosmed K2 (intermediate technology) helped to develop a practical and repeatable protocol for testing children with disability using the Cosmed K4. The protocol commenced with 5 minutes of rest to achieve baseline values of heart rate and oxygen consumption, followed by 10 minutes of continuous walking at a self-selected speed on a 10-metre level oval walking track. The test concluded with 5 minutes of rest to monitor the return to baseline values. Ninety-one percent of the children with disability quickly reached a steady-state of oxygen consumption and carbon-dioxide production. The carbon-dioxide sensor in the Cosmed K4 has enabled a new group of severely involved children with cerebral palsy (9%) to be defined. These children have been termed 'physiologically marginal ambulators'.

Adult↗
PubMed1999

Clients speak: participatory evaluation of a nonconfrontational addictions treatment program for older adults.

OBJECTIVES: To describe the important aspects of the Lifestyle Enrichment for Senior Adults (LESA) program from the clients' perspective and why these aspects were important to them. METHODS: The study used a participatory approach. Researchers collaborated with counselors and clients to develop an evaluation that (a) respected the experiences and knowledge of people in the program and (b) provided an accurate assessment of the important aspects of the program from the clients' perspective. One-to-one interviews were conducted with 52 clients. RESULTS: Clients' relationships with counselors, the positive emotions experienced during individual and group counseling, and the program's flexibility were of key importance. Allowing clients to choose their level of involvement and the general acceptance of drinkers also contributed to perceived benefits of the program. DISCUSSION: The benefits of client-centered addictions therapy warrant closer examination. Senior adults' motivation for behavior change may be highly sensitive to the relational aspects of the treatment approach.

Age Factors↗
PubMed1999

Alcohol use and psychosocial well-being among older adults.

OBJECTIVE: The objective of this study was to examine the relationships of three dimensions of alcohol consumption (frequency of drinking, usual total weekly consumption and quantity per occasion) with social and leisure status, stress and psychological well-being among people ages 65 and older. METHOD: Nurse interviewers completed in-house surveys with 826 older persons (65% women) in one community (67% response rate of the census sample). RESULTS: Overall, relationships tended to be modest or nil. Those relationships between negative functioning and heavier alcohol use that did emerge tended to be associated with higher quantity drinking (i.e., drinks per drinking day) and to some extent volume, but not with frequency of drinking. Of the psychosocial variables, poorer psychological well-being, especially depression, was most highly correlated with heavier drinking. These results were the same controlling for sex, age, education, health and use of depressant medications. CONCLUSIONS: Higher quantity and volume of alcohol use among older people show a modest positive association with poorer psychological well-being, independent of other potentially confounding variables such as sex, age, health or use of depressant medications. Frequency of drinking, however, was not related to psychosocial status.

Aged↗
PubMed1999

The relationship between psychosocial well-being and alcohol and drug use following substance misuse treatment.

The relationship between psychosocial status and alcohol and drug use at 12-month follow-up was evaluated for clients of two addictions treatment programs (90 treated for alcohol; 51 for drugs or drugs and alcohol). Psychosocial status at follow-up was mostly unrelated to alcohol use among clients who were not using drugs prior to treatment. Among drug users, returning to both alcohol and drug use was strongly associated with poorer psychosocial status, with partial correlational analyses indicating that (a) drug use was the main factor associated with poorer status and (b) poorer status was likely a consequence rather than a precursor of drug use. The implications of these findings are discussed.

Adult↗
PubMed1998

Long-term effects of low-density lipoprotein apheresis using an automated dextran sulfate cellulose adsorption system. Liposorber Study Group.

The short-term effectiveness of low-density lipoprotein (LDL) apheresis using a dextran sulfate cellulose adsorption column technique was previously examined in a 9-center, 22-week controlled trial in 64 patients with familial hypercholesterolemia (FH) who did not adequately respond to diet and drug therapy. Forty-nine patients (40 treatment, 9 controls) subsequently received LDL apheresis procedures as part of an optional follow-up phase. This study reports on the long-term safety, lipid lowering, and clinical efficacy of LDL apheresis for the 5-year period that includes both the initial controlled study and follow-up phase. During this time, patients received a total of 3,902 treatments of which 3,314 treatments were given during the follow-up phase. Adverse events were infrequent, occurring in 142 procedures (3.6%). Immediate reduction in LDL cholesterol was 76% both in homozygotes and in heterozygotes. Patients with homozygous FH had a progressive decrease in pretreatment LDL cholesterol level along with an increase in high-density lipoprotein (HDL) cholesterol level. There was no appreciable change in pretreatment lipoprotein level over time in heterozygotes. The rate of cardiovascular events during therapy with LDL apheresis and lipid-lowering drugs was 3.5 events per 1,000 patient-months of treatment compared with 6.3 events per 1,000 patient-months for the 5 years before LDL apheresis therapy. These findings support the long-term safety and clinical efficacy of LDL apheresis in patients with heterozygous and homozygous FH who are inadequately controlled with drug therapy.

Adolescent↗
PubMed1998

Analyses of use of tranquilizers and sleeping pills across five surveys of the same population (1985-1991): the relationship with gender, age and use of other substances.

The present study used analyses of data from five surveys of the same population over a 6-year period to examine the relationship of use of tranquilizers/sleeping pills with gender, age and use of other psychoactive substances. Part of the study involved identifying methodological issues in using surveys to study tranquilizer/sleeping pill use. Across surveys and within all age groups, females were more likely to use tranquilizers and/or sleeping pills than males, with an average ratio overall of a little higher than three to two (varying across surveys from 1.4 to 2.1; mode of 1.6). Prevalence rates for both females and males were strongly affected by timeframe over which use was measured. Use of tranquilizers/sleeping pills increased with age; however, the relationship with age was different for tranquilizers than for sleeping pills. For tranquilizers, the high correlation between age and use was largely attributable to the low rate of use by those aged 34 and younger. For sleeping pills, on the other hand, the relationship is based more on the high rate of use by those aged 65 and older. In addition, age was a major factor in nonmedical use of tranquilizers/sleeping pills, with nonmedical use decreasing dramatically with age. Use of other types of psychoactive medications was significantly higher among tranquilizer/sleeping pill users than among non-users. The results pertaining to concurrent use of tranquilizers/sleeping pills and alcohol, marijuana, and tobacco, however, showed some trends, but findings were not consistent across all surveys. Further analyses suggested that this lack of consistent findings might be attributable to survey design issues, in particular, the extent that the format of the survey question tended to exclude nonmedical users. The implications of these results for future research on tranquilizer/sleeping pill use are discussed.

Adolescent↗
PubMed1998

Current directions in research on understanding and preventing intoxicated aggression.

The present paper describes promising research directions that emerged from a recent international conference on intoxication and aggression and from the scientific literature generally. In this overview, intoxicated aggression is seen as arising from an interactional process involving multiple contributing factors or causes. This model helps to define research directions that can further understanding and prevention. First, the societal/cultural framing of intoxication and aggression exerts a powerful influence on drinking behaviour and needs to be better understood. Another important area for research is the moderating role on alcohol-related aggression of personal factors such as predisposition to aggression and individual differences in expectations about alcohol and aggression. Research on the role of basic pharmacological effects of alcohol in increasing the likelihood of aggressive behaviour is also a critical aspect of understanding intoxicated aggression. Drinking contexts and environments play a considerable role in the relationship between intoxication and aggressive behaviour and need to be better understood. Another critical direction for future research is the study of intoxicated aggression as a process involving the interaction of the person, the situation and the effects of alcohol in natural and experimental settings. Finally, the paper highlights promising directions for research on interventions to prevent intoxicated aggression and violence.

Aggression↗
PubMed1998

Blame and punishment for intoxicated aggression: when is the perpetrator culpable?

AIM: To systematically test the hypothesis that intoxicated individuals are viewed as less culpable than relatively sober individuals for engaging in aggressive behaviour. DESIGN: A series of experimental vignettes depicted alcohol use in the context of unwanted touching, date rape, assault and rape, vandalism and common assault. Each vignette manipulated drinking of the perpetrator and selected contextual variables using between-subjects experimental designs. SETTING: A stratified random sample of 994 Ontario residents responded to these scenarios in the course of a telephone interview. MEASUREMENTS: Three measures were analysed in this study: (1) judgements of the causal role of the perpetrator's drinking in leading to each outcome, (2) perceived blameworthiness of the perpetrator, and (3) appropriate punishment for the perpetrator. FINDINGS: Drinking was believed to play a greater causal role in leading to each outcome when the perpetrator was portrayed as "drunk" as opposed to merely "feeling the effects". However, intoxication did not attenuate perceived blameworthiness and only inconsistently reduced punishment assigned to perpetrators. Instead, intoxication interacted with premeditation, criminal history and gender to determine perceived culpability of perpetrators. In some scenarios, victim intoxication reduced perceived culpability of the perpetrator. CONCLUSIONS: Legal, anthropological, and attributional accounts may overestimate the extent to which perpetrator intoxication--in and of itself--determines perceived culpability for alcohol-related aggression.

Adult↗
PubMed1998

Drinking patterns, psychosocial characteristics and alcohol consequences.

AIMS: The purpose of this study was to investigate (a) the potential mediating role of alcohol consumption in the relationship between psychosocial variables and adverse consequences of drinking, and (b) the possible moderating role of psychosocial variables in the relationship between alcohol consumption and adverse consequences. DESIGN: Multi-stage sampling procedures were used to select households for a general population survey. Interviews were conducted with one member in each of 35, 479 households and self-administered questionnaires were left for all residents aged 12 years and older (N = 49 164, response rate: 77.2%). SETTING: Data were collected as part of the Ontario (Canada) Health Survey. PARTICIPANTS: The present study included 33, 568 current drinkers aged 18 or older. MEASUREMENTS: Analyses included the following variables: alcohol consumption, adverse consequences related to drinking, sex, age, marital status, self-rated health, perceived stress, income, education, employment status and family dysfunction. FINDINGS: Alcohol consumption appeared to mediate the relationship of adverse consequences with age, sex, marital status, education, income and employment, but not with health, stress or family dysfunction which were independently associated with adverse consequences. The relationship between alcohol consumption and adverse consequences was moderated by age, marital status, education and employment. CONCLUSIONS: These results help to clarify the interrelationship of alcohol consumption and psychosocial characteristics in experiencing adverse consequences related to drinking.

Adult↗
PubMed1998

Should alcohol consumption measures be adjusted for gender differences?

Because of biological differences between men and women, the same quantity of alcohol consumed over the same time period produces higher blood alcohol levels (BALs) in women than in men. Some alcohol researchers have proposed that quantity and volume measures of alcohol consumption (e.g. usual number of drinks per drinking day and overall amount of alcohol consumed) should be adjusted to reflect these biological differences. To date, no standard adjustment for biological gender differences has been adopted. In this paper, we review the literature on biological and behavioral differences related to alcohol consumption and effects and discuss the implications of these differences in terms of adjusting alcohol consumption measures. Our review suggests that adjusting measures of alcohol consumption to compensate for biological sex differences is most appropriate for research or policy applications involving the short and long-term physiological effects of alcohol in contexts where gender differences in how alcohol is consumed can be assumed to be minimal. In other circumstances, non-biological gender differences relating to alcohol use, such as pace of drinking, may moderate the relationship between alcohol consumption and biological gender differences, making an adjustment less defensible. We also identify areas where more knowledge is needed not only to address the issue of adjusting alcohol measures for gender differences but also to understand better the relationship between alcohol consumption and effects.

Alcohol Drinking↗