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Biomedical subjects

P Griffiths

Publications and source records attributed to P Griffiths.

At least 19 recordsLinked to original sources
PubMed1992

The study of transitions in the route of drug use: the route from one route to another.

Route of administration of various drugs is an area of study to which specific attention must be paid in study of different HIV risks of drug use by various routes. If changes in route are seen in individuals or within populations, then study of these transitions in route may identify new approaches which could be developed in HIV prevention. The consideration in this paper is based around ten questions: (i) What is a transition? (ii) Do routes of administration vary by time and place? (iii) Is choice of route influenced by availability of drug paraphernalia? (iv) How does the context influence initial choice of administration, and possible subsequent transitions? (v) Are lapse and relapse meaningful concepts? (vi) Transitions: how much of it is going on? (vii) How much does change of route (with the same drug) signify a change of drug effect, its significance, or its relationship with other risk behaviour? (viii) Is change of route of use of one drug always accompanied by the same change of route of other drugs? (ix) Injectors/non-injectors and sharers/non-sharers: do these behavioural characteristics exist as categories or are they distributed along a continuum? (x) Are transitions reversible? This paper is accompanied by two research reports which describe explorations into the extent and nature of transitions amongst heroin users.

Cocaine↗
PubMed1992

Extent and nature of transitions of route among heroin addicts in treatment--preliminary data from the Drug Transitions Study.

Preliminary data are presented here from a study of drug transitions in the UK. These support the contention that differences in route of administration are likely to be reflected in differing patterns of drug use, and associated with differing health risks for the individual drug user. Heroin 'chasers' were found to have robust and long-term patterns of heroin use and could not merely be considered as pre-injectors. They were also younger. No differences were found in the typical daily doses prior to entering treatment between chasers and injectors. Subjects who usually 'chased the dragon' but who would also inject were less likely to have shared injecting equipment in the past. Transitions between different routes of use were found in most directions. However, changes from 'chasing' to injection were most common. Year of initiation into heroin use was also related to initial route of use.

Drug Administration Routes↗
PubMed1992

Severity of dependence and route of administration of heroin, cocaine and amphetamines.

This study investigates severity of dependence upon heroin, cocaine and amphetamines in a group of 200 heroin users, 75% of whom were not in contact with any treatment agency. For drug takers who were current users of more than one drug, heroin produced more severe dependence than either cocaine or amphetamine and many users of these stimulant drugs reported having experienced no problems of dependence. Severity of dependence was influenced by route of administration as well as type of drug. Heroin taken by injection was associated with more severe dependence than smoked heroin. For cocaine, injection and smoking were associated with equivalent dependence ratings, and both of these routes were associated with more severe dependence than cocaine used intranasally. For amphetamine, there were no differences in severity of dependence ratings for injection, intranasal or oral use. Severity of dependence was correlated with dose and duration of drug use; it was also associated with previous attendance at a drug treatment agency, though dependence problems were also common among heroin users who had never received treatment. Implications of these findings are discussed.

Adult↗
PubMed1992

Quality of life improvements in CAPD patients treated with subcutaneously administered erythropoietin for anemia.

Twenty-two continuous ambulatory peritoneal dialysis (CAPD) patients, mean age 48 years, at 3 U.K. renal units were assessed with the Nottingham Health Profile (NHP) before and after treatment with recombinant human erythropoietin (r-HuEPO). Mean (SD) hemoglobin (Hb) at baseline was 7.5 (1.0) gm/dL and 10.8 (1.5) gm/dL at retest. There were significant improvements in energy (p less than 0.0001), social life (p less than 0.005), relationships at home (p less than 0.05) and leisure pursuits (p less than 0.05). Twelve patients, mean age 51 years, who had already completed more than 9 months on r-HuEPO treatment were reassessed to determine the changes sustained. Mean (SD) Hb at second retest was 12.8 (1.3) gm/dL. Improvement in energy continued to be significant, and emotional wellbeing showed further improvement. Problems with household tasks, which had not shown significant improvement at Test B, were now considerably reduced (p = 0.016). The study showed far-reaching benefits similar to those reported in hemodialysis patients, in a population with a higher mean age and higher potential coexisting illness or disability than most reported hemodialysis studies.

Activities of Daily Living↗
PubMed1991

Progression of HIV disease in a haemophilic cohort followed for 11 years and the effect of treatment.

OBJECTIVE: To describe the progression of HIV disease in a haemophilic cohort and to show the influence of treatment. DESIGN: 11 year longitudinal clinical and laboratory study. SETTING: A haemophilia centre. PATIENTS: 111 patients infected with HIV during October 1979 to July 1985. MAIN OUTCOME MEASURES: Symptoms of HIV infection, AIDs, and death. INTERVENTIONS: 26 asymptomatic patients started taking zidovudine or placebo (1000 mg/day) during November 1988 to February 1990; 10 patients with CD4+ counts of 0.2 x 10(9)/l started zidovudine 500 mg/day during January to November 1990. 35 patients used pentamidine for primary or secondary prophylaxis. RESULTS: At 11 years from seroconversion the estimated rate of progression to AIDS was 42% (95% confidence interval 27% to 57%); to symptoms 85% (75% to 95%); and to death 41% (25% to 57%). Progression to AIDS was significantly faster in patients aged 25 and over than in those aged less than 25 (relative risk 5.0 (2.4 to 10.4); p less than 0.00001) and in those with previous cytomegalovirus infection than in those not infected (relative risk 3.0 (1.4 to 6.8); p = 0.006). 16 of 27 (59%) patients with p24 antigenaemia developed AIDS compared with 17 of 84 (20%) patients without p24 antigen (p less than 0.001). The risk of progression to AIDS before 30 November 1988 in patients with CD4+ counts less than or equal to 0.2 x 10(9)/l was higher than after November 1988 (relative risk 1.9 (0.85 to 4.43); p = 0.1). For 1989 and 1990 the observed cumulative numbers of AIDS cases (among 81 patients with sufficient CD4+ counts) were 22 and 25 compared with 29 and 37 predicted from the rate of fall of CD4+ counts up to the end of 1988 (p = 0.03). CONCLUSION: Treatment seems to be reducing the progression of HIV disease in this haemophilic cohort.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Should opiate addicts be involved in controlling their own detoxification? A comparison of fixed versus negotiable schedules.

This study compares the responses of opiate addicts at a London drug treatment centre to two outpatient methadone-based detoxification programmes. These involved either a fixed (non-negotiable) dose reduction schedule or a flexible, negotiable withdrawal schedule. In the negotiable condition, subjects were less likely to complete the detoxification programme and the mean reduction in dose achieved by the subjects in the negotiable condition was less than that in the fixed group. There was no difference between groups in programme retention at 6 weeks though subjects who remained in treatment in the negotiable group tended to extend their detoxification period beyond this point. The overall response of subjects in both groups was unsatisfactory. Only 13% of the subjects initially allocated to detoxification or 28% of those who actually started detoxification completed treatment; urine screening showed that heroin abuse was a continuing problem during treatment. The implications of these results for detoxification and drug treatment services are discussed.

Adult↗
PubMed1991

Word-finding ability and design fluency in developmental dyslexia.

Certain oral as well as visual language disorders now appear characteristic of the developmental dyslexia syndrome. Recent research has revealed word-finding difficulties in dyslexic children but has left unanswered questions about specificity and causality. Verbal and non-verbal fluency in dyslexics and non-dyslexic CA- and RA-matched controls were measured by means of cued lexical retrieval and stick design tasks. Evidence for dyslexia-related difficulties was found only at the word form level of access. At the semantic level, dyslexics' word finding was superior. Non-verbal (design) fluency was normal. Such findings implicate long-term linguistic memory processes in dyslexia and are consistent with neurocognitive models that emphasize diffuse left hemisphere dysfunction.

Attention↗
PubMed1991

Chasing the dragon.

Explore the source record for details and available documents.

Administration, Inhalation↗
PubMed1990

Crack and cocaine use in south London drug addicts: 1987-1989.

There has been great concern in recent years about the abuse of cocaine, particularly in its smokable form 'crack'. This paper presents data drawn from 441 patients seen by a South London Community Drug Team between 1987 and 1989. Only four (1%) cited cocaine abuse as the main drug problem. Heroin was the most common main drug. Detailed information was available on 355 of these subjects. During the study period 63 patients reported using cocaine and the proportion of subjects using cocaine increased from 13% to 29%. Within the sub-group of cocaine users, there was a marked increase in the use of smokable forms of cocaine from 15% in 1987 to 75% in 1989. In view of the increased dependence risk associated with smoking cocaine, this is seen as an ominous development.

Adult↗
PubMed1990

Elevated viral antibody titres in spontaneous abortion.

To assess the possible role of virus infections in spontaneous abortion we undertook a prospective study of three groups of patients: women who had a spontaneous abortion; women seen in the antenatal booking clinic; and those undergoing therapeutic termination of pregnancy. Venous blood was taken for antibody detection, cervical swabs for virus isolation, and in the cases of spontaneous and therapeutic abortion products of conception were sent for virus culture. The infectious agents studied were influenza A and B, adenovirus, respiratory syncytial virus, measles, psittacosis, Varicella zoster, and mumps virus. Statistical analysis revealed that women in the spontaneous abortion group has a higher incidence of antibodies against respiratory syncytial virus (P less than 0.01), and mumps virus (P less than 0.01). Among women seropositive for each virus, higher titres were found only for respiratory syncytial virus (P less than 0.05) in cases rather than controls. These results could be explained if viruses such as respiratory syncytial virus caused abortion or if women having a spontaneous abortion mount exaggerated immune responses to fetal and viral infections, and the former altered immune response is associated with spontaneous abortion.

Abortion, Spontaneous↗
PubMed1990

Antibody response after hepatitis B immunisation in a group of health care workers.

Hepatitis B immunisation has been offered to staff of Hampstead Health Authority since 1982 and is now offered to all staff with clinical contact. Three doses of 20 micrograms of vaccine are given at zero, one, and six months and the antibody response is measured three months later. Results were analysed to seek for associations with the antibody response. At the time of analysis, 2739 people had started vaccination and 1067 had completed the course and had a measurement of antibody response. Vaccine injections were initially into the buttock and later into the arm; measurement of antibody levels was initially by radioimmunoassay (RIA) and later by enzyme immunoassay (EIA). A positive antibody response was defined as a positive/negative ratio of greater than 10 for RIA or a level of greater than 10 mIU/ml for EIA. Associations between antibody response and other variables were tested by chi 2 and a multiple logistic regression analysis was undertaken to examine the effects of variables in combination. The overall antibody response rate was 95%. Men and women did not respond differently but there were significantly more positive responses with the EIA testing method and a tendency for more positive responses with arm injections. The responders were significantly younger than the non-responders and had significantly lower values of body mass index (wt/ht2).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Clonidine versus long- and short-term methadone-aided withdrawal from opiates. An uncontrolled comparison.

Twelve heroin addicts and one methadone addicts began withdrawal from street opiates, under clonidine cover, in a general psychiatric ward. Ten (80%) of them completed it within 6 days. Clonidine doses used were lower than in similar studies and all patients were alert and mobile throughout withdrawal. Two other groups of opiate addicts, of similar age and sex, were withdrawn on standard methadone regimens. Clonidine and methadone withdrawal had similar acceptability and attrition rates. Self-reports of subjective discomfort were higher in the clonidine group without affecting compliance with treatment. Withdrawal under clonidine cover deserves further study, in view of the need for postwithdrawal treatment to prevent relapse to opiate use.

Adult↗
PubMed1989

Low inspired gas temperature and respiratory complications in very low birth weight infants.

We analyzed 3705 measurements of inspired gas temperature in the first 96 hours of life, with concurrent measurements of ventilator variables and arterial oxygen tension, to determine any relationship to respiratory sequelae in 149 infants assisted by artificial ventilation. All management was with one type of ventilator (model IV100B, Sechrist Industries Inc., Anaheim, Calif.) and one type of humidifier (model MR 500, Fisher and Paykel, Auckland, New Zealand), and infants were placed under radiant heaters. Outcome for infants weighing greater than or equal to 1500 gm at birth was no different at low (less than or equal to 36.5 degrees C) versus high (greater than 36.5 degrees C) values of mean inspired gas temperature during the first 96 hours. However, infants weighing less than 1500 gm at birth had less respiratory morbidity at the higher temperatures; there was a reduction in the incidence of pneumothorax from 43% at low to 13% at high temperatures (p = 0.006) and a reduction in the severity of chronic lung disease, measured as mean Fio2 at 29 days in survivors, from 37.2% at low to 27.5% at high temperatures (p = 0.001). Clinical evaluation of the humidifier, as it was used in this study, suggested that temperature settings less than 36.5 degrees C were associated with inspired gas humidity between 28 and 36 mg H2O/L. For any humidifier, there may be a critical threshold for inspired gas humidity below which the risk of respiratory complications in very low birth weight babies is increased. This hypothesis requires rigorous scrutiny by controlled trial. In future studies, direct measurements of inspired gas humidity are needed to make a precise estimate of the optimal level.

Blood Gas Analysis↗