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Biomedical subjects

M D Lambert

Publications and source records attributed to M D Lambert.

14 recordsLinked to original sources
PubMed1996

Essential and reactive alcoholism: a review.

Methodological characteristics and substantive findings of investigations of essential and reactive alcoholics were reviewed. The data base was comprised of approximately 12 studies published between 1951-1992, most of which employed small samples of hospitalized male alcoholics. Psychometric properties of the Essential-Reactive Alcoholism Questionnaire, the instrument generally used to assess the essential-reactive dimensions, rarely were examined. The weight of the evidence suggests that essential alcoholics have earlier onset and greater severity of alcoholism, lower levels of occupational and educational achievement, more interpersonal conflict, fewer long-term friendships, more antisocial attitudes and conduct, greater density of familial alcoholism, more impaired neuropsychological functioning, and lower resting blood pressure than do reactive alcoholics. Research is needed to assess the prognostic utility of the essential-reactive typology and the degree to which the distinction may facilitate patient-treatment matching.

Alcoholism↗
PubMed1996

Alcohol abuse in urban Indian adolescents and women: a longitudinal study for assessment and risk evaluation.

Empirical studies of American Indian health and mental health have focused primarily on reservation samples or small cross-sectional school-based or treatment samples. Few studies have addressed these issues among urban American Indian populations. This paper introduces an ongoing ten-year prospective longitudinal study of alcohol abuse, drug abuse, and mental health status in a community sample of urban American Indian adolescents and women. The study uses structured interviews and diagnostic assessments to identify risk factors for, and measure prevalence of, alcohol abuse, drug abuse, and psychopathology in 523 Indian youth and 276 Indian women. Study aims, rationale, research design, methods, sample characteristics, assessment instruments, and substance use prevalence are described, and methodological issues related to conducting longitudinal research are discussed.

Adolescent↗
PubMed1995

Diagnosis and hospital readmission rates of female veterans with substance-related disorders.

OBJECTIVES: The study examined the prevalence of substance use, psychiatric, and medical disorders in female veterans discharged from VA hospitals. METHODS: The VA discharge abstract database was used to identify women discharged in fiscal year 1991 who received a diagnosis of substance abuse or dependence or substance-induced psychosis (N = 1,698). They were compared with female veterans who did not receive a substance-related diagnosis (N = 12,037). RESULTS: Alcohol and cocaine use disorders were the most prevalent substance use disorders. Women with substance use disorders were more frequently diagnosed as having personality disorders, depression, and posttraumatic stress disorder than women without substance use disorders. Skin and subcutaneous tissue diseases, infectious and parasitic diseases, and digestive diseases were more prevalent among women with substance use disorders than among women in the same age group who did not have substance use disorders. Approximately 44 percent of women with substance use disorders who were discharged during the first six months of fiscal year 1991 were rehospitalized within that year. CONCLUSIONS: Substance use disorders and associated comorbidities are endemic among women treated in VA hospitals. Additional studies examining characteristics of indigent women with substance use disorders are needed.

Adult↗
PubMed1994

Maternal smoking during lactation: relation to infant size at one year of age.

This study was conducted to test the hypothesis that breast-fed infants of smokers are smaller in size at 1 year of age than breast-fed infants of nonsmokers. Three groups of infants were selected from all singletons born to women who were seen for prenatal care in their 6th month of pregnancy at a health maintenance organization in Seattle, Washington, between January 1982 and April 1983. Breast-fed infants of smokers (n = 74) were compared with breast-fed infants of nonsmokers (n = 195) and with bottle-fed infants of smokers (n = 64). Mothers were interviewed at 1 and 3 months after delivery; both the mother and the infant were seen at 1 year. Among breast feeders, smokers' infants were twice as likely as nonsmokers' infants to have body mass more than 1 standard deviation above the mean (relative risk = 2.04, 95% confidence interval 1.15-3.61). This relation persisted after control for gestational age and weight at birth, length of lactation, mother's size and diet, exposure to other drugs in breast milk, and all other variables measured in this study. Every 10 cigarettes smoked while breast feeding predicted an additional 3% infant body mass at 1 year. In summary, breast-fed infants of smokers in this study gained more weight after birth than the other two groups; at 1 year of age, they were heavier and had significantly higher body mass. Reasons for this paradoxical finding are explored.

Adult↗
PubMed1994

Psychiatric and medical comorbidities of veterans with substance use disorders.

OBJECTIVE: The authors examined patterns of substance use disorders and psychiatric and medical comorbidity in all male veterans treated in Veterans Affairs (VA) medical centers during a one-year period. METHODS: A national discharge abstract data base was used to derive point prevalence rates of psychiatric and medical disorders for 539,557 inpatients treated in VA medical centers in fiscal year 1991. RESULTS: Nearly one-quarter of all male veterans treated in the study year had a substance-related diagnosis. The most prevalent substance use disorders were alcohol dependence (87.7 percent) and cocaine dependence (17.5 percent), and the most frequent psychiatric diagnoses among veterans with substance-related diagnoses were depression and personality disorders. Digestive disorders were more prevalent among veterans who abused substances than among veterans who did not, and veterans who abused substances were also more likely to have multiple hospitalizations and longer index hospital stays. CONCLUSIONS: Substance use disorders and comorbid psychiatric syndromes are common in male veterans treated in VA hospitals. Veterans with substance-related diagnoses may have longer hospital stays and more frequent hospitalizations than veterans without substance use disorders.

Adult↗
PubMed1994

Medical practice guidelines.

Prescriptive standards of clinical conduct--practice guidelines--have proliferated throughout medicine over the past decade. Practicing physicians are confronted with a plethora of guidelines developed for different purposes by a diverse body of public and private organizations. We review factors contributing to the growth of guidelines, their desirable features, and consequences, legal and otherwise, of implementing guidelines. Few studies have examined whether, and under what conditions, guidelines are effective in changing physicians' practices and patients' health. Nonetheless, expectations for guidelines remain high because they are one of the only instruments of health care reform that promises to improve the quality of care while reducing overall health care costs. Efforts to develop guidelines are likely to continue unabated for the foreseeable future. Additional research comparing different methods of developing and disseminating guidelines is needed.

Practice Guidelines as Topic↗
PubMed1990

Drinking and smoking at 3 months postpartum by lactation history.

A spontaneous decrease in maternal drinking and smoking often occurs during pregnancy. The present study was conducted to determine if these lower levels of maternal drinking and smoking during pregnancy persist into the postpartum period, and if so, to determine if they are related to breastfeeding. Drinking and smoking were estimated in three cohorts of postpartum women who had been followed since pregnancy. The first group never breastfed their infants; the second group breastfed for less than 1 month; the third group breastfed for more than three months. (Women who weaned between one and three months were not studied). Drinking and smoking in all three groups decreased sharply during pregnancy but rose again in the 3 months after delivery, though not to levels that were reported before conception. Usual drinking in the third month postpartum did not differ significantly among the three lactation groups. However, women who were still nursing were less likely to report occasional episodes of heavy drinking (binges) in this month than women who had weaned early or never breastfed. Women nursing in the third month postpartum were also significantly less likely to smoke during the month; if smoking, they were less likely to smoke heavily. These differences in postpartum drinking and smoking were not due entirely to habits before conception or to the influence of other potentially confounding variables.

Alcohol Drinking↗
PubMed1989

Dietary cravings and aversions in the postpartum period.

Although food cravings and aversions are commonly experienced by pregnant women, the degree to which they persist in the postpartum period is unknown. This study examines this issue in both lactating and nonlactating women. A random sample of 463 subjects was selected from all prenatal patients receiving care at a large health maintenance organization (HMO). Even though almost all of the subjects reported craving some food or beverage during the last trimester of pregnancy and half reported some aversion, those phenomena dropped markedly in the postpartum period. Evaluation of dietary quality as related to food cravings revealed no clear association; that is, the data provided no evidence to support the hypothesis that cravings are caused by dietary deficiencies or that they result in significantly augmented intake of key nutrients found in those foods. Overall, food cravings and aversions do not continue into the postpartum period at a higher rate than one would expect in the adult female population; manifestation of food cravings/aversions is not related to dietary quality.

Female↗
PubMed1988

Amlodipine in elderly hypertensive patients: pharmacokinetics and pharmacodynamics.

Elderly (65-73 years) and young (28-34) hypertensive patients received amlodipine by i.v. infusion (2.5, 5.0, or 10.0 mg). Patients were then started on oral amlodipine 2.5 mg daily for 2 weeks, at the end of which amlodipine disposition and effect were evaluated over one 24-h dose interval. Patients were treated subsequently with amlodipine in an escalating dose protocol (maximum 10.0 mg once daily) for 12 weeks to control blood pressure. After i.v. amlodipine, clearance tended to be decreased in elderly as compared with young patients with resulting prolongation in elimination half-life (64 +/- 20 vs. 48 +/- 8 h; mean +/- SD). Maximum decrease in systolic blood pressure (SBP) after i.v. doses tended to be greater in the elderly (-34 +/- 15 vs. -23 +/- 15 mm Hg) and maximum decrease in diastolic blood pressure (DBP) was similar in the two groups (-21 +/- 10 vs. -18 +/- 7 mm Hg). SBP was significantly decreased after 14 weeks' therapy in the elderly at doses ranging from 2.5 to 10.0 mg per day (171 +/- 17 to 149 +/- 22 mm Hg; p less than 0.01). DPB was decreased both at 2 and 14 weeks' therapy in the elderly (baseline 100 +/- 7, 2 weeks 93 +/- 5, 14 weeks 90 +/- 5 mm Hg; p less than 0.01 vs. baseline).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1977

Nitrogenase of Klebsiella pneumoniae. Water proton NMR relaxation studies on the binding of divalent metal ions and nucleotides to the iron protein.

Interactions between the iron protein, Kp2, of nitrogenase manganese ions, magnesium ions, and the nucleotides ATP or ADP, have been studied in aqueous solution by monitoring the water proton NMR relaxation rate enhancement caused by Mn2+. Binding of Mn2+ to a molecule of Kp2 occurs at four sites, indistinguishable within experimental error, having a Kd = 350 +/- 50 micron. The Mn2+ - Kp2 complex has a low characteristic enhancement (epsilonb = 6 +/- 0.5). All four sites can alternatively bind Mg2+, not necessarily with the same dissociation constant, but with a mean Kd = 1.7 +/- 0.3 mM. Ternary complexes with the configuration EMS or (formula: see text) are formed between Kp2, Mn2+ and nucleotide (ATP or ADP). The ternary complexes with Mg2+ in place of Mn2+ probably have the latter configuration. A novel treatment of enhancement data (a 'high metal' approximation) is given.

Adenosine Diphosphate↗
PubMedDate not supplied

Treatment implications of comorbid psychopathology in American Indians and Alaska Natives.

This paper discusses treatment implications of comorbid psychopathology in the context of American Indian and Alaska Native culture and in the context of the Indian Health Service's Mental Health and Alcohol and Substance Abuse Program Branches. Treatment of comorbidity in this population is a particularly difficult problem due to numerous barriers to treatment and a poorly defined treatment system. As in other clinical populations, these patients are high utilizers of the limited treatment services available, but may not receive the type of treatment they need. After describing the extent of comorbidity in this population, we present an historical perspective of mental illness that provides an Indian's view of why we are where we are today in treating these problems. Next, we discuss Western and traditional treatment implications for comorbidity among adults and adolescents. Finally, we suggest directions for future research in this area.

Alaska↗
PubMedDate not supplied

Practice guidelines in the addictions. Recent developments.

Consensually established principles of clinical conduct, known variously as practice guidelines, standards, protocols, or algorithms, have proliferated throughout medicine over the past decade. Institutional and disciplinary efforts to develop and promulgate guidelines for the treatment of additive disorders have recently been initiated. We review guideline development activities of the American Psychiatric Association, American Psychological Association, American Society of Addiction Medicine, American Nurses Association, National Association of Social Workers, and Center for Substance Abuse Treatment of the Substance Abuse and Mental Health Services Administration. Medical care performance and outcome assessments are discussed with attention to the role they can play in evaluating and refining guidelines. Potential effects of guidelines, salutary and deleterious, on clinical practice in the addictions are delineated.

Forecasting↗
PubMedDate not supplied

Substance dependent American Indian veterans: a national evaluation.

Demographic, clinical, and treatment episode characteristics of 3,087 American Indian veterans discharged from Department of Veterans Affairs hospitals in fiscal year 1991 were examined. Substance use disorders were diagnosed in 46.3 percent of discharged American Indians, compared with 23.4 percent of discharged veterans overall. More than 97 percent of American Indian substance use diagnoses were for alcohol dependence, while rates of other drug use disorders were low. Substance dependent American Indians were younger, and more likely to be male and unmarried, than nondependent American Indians. Psychiatric disorders, particularly personality disorders, depression, and posttraumatic stress disorders, were more prevalent among American Indians diagnosed with substance use disorders, than among nondependent American Indians. American Indians with substance use disorders were similar demographically to the general population of substance dependent veterans. Rates of diagnosed psychiatric disorders and drug dependencies other than alcohol were lower among American Indians receiving substance (alcohol or drug) use diagnoses than among the general population of substance dependent veterans. Rates of rehospitalization following discharge were higher in substance-abusing American Indian veterans than among their counterparts. Potential explanations for these findings are discussed.

Adult↗