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Biomedical subjects

R A Blizard

Publications and source records attributed to R A Blizard.

9 recordsLinked to original sources
PubMed1997

Impairment, disability and handicap as risk factors for depression in old age. The Gospel Oak Project V.

BACKGROUND: An association between disablement and late-life depression is often reported in cross-sectional studies. However, many lack effect sizes, and do not control for confounding. Therefore, it is difficult both to quantify the overall impact of poor health on depression and to understand which aspects are most salient. METHODS: A catchment area survey of all over 65-year-old residents of an electoral district in London, UK, using a population register derived from a door-to-door census was undertaken. Depression was measured using SHORT-CARE, and the consequences of disease classified according to the WHO International Classification of Impairments, Disabilities and Handicaps. RESULTS: Six hundred and fifty-four subjects were interviewed out of an older population of 889. The prevalence of SHORT-CARE pervasive depression was 17%. Impairment, disability and, particularly, handicap were strongly associated with depression. The adjusted odds ratio for depression in the most handicapped quartile compared with the least was 24.2 (8.8-66.6). The population attributable fraction (PAF) for depression attributable to handicap was 0.78. The PAFs for recent life events and female gender were much lower. Handicap explained most of the depression associated with individual impairments and disabilities. Adjusting for handicap abolished or weakened the associations between depression and social support, income, older age, female gender and living alone. CONCLUSIONS: Even given some uncertainty in distinguishing handicap and depression as constructs, and the impossibility of deciding direction of causality, it seems likely that handicap is of central significance to late-life depression. Handicap may be more amenable to intervention than either impairment or disability.

Activities of Daily Living↗
PubMed1997

Social support deficits, loneliness and life events as risk factors for depression in old age. The Gospel Oak Project VI.

BACKGROUND: A companion paper reported a very strong cross-sectional association between handicap and late-life depression. Adjusting for handicap weakened associations between sociodemographic variables and depression. It was unclear whether handicap was a confounder, or a useful summary variable, mediating the effect of a range of sociodemographic disadvantages. This paper focuses on the cross-sectional relationship between depression and demographic variables, social support, and life events. METHOD: A community survey of all residents over the age of 65 years of an electoral district in London, UK. RESULTS: There was a moderate association between SHORT-CARE pervasive depression and the number of life events experienced over the previous year. Personal illness, bereavement and theft were the most salient events. There was a stronger, graded, relationship between the number of social support deficits (SSDs) and depression. Number of SSDs also related to age, handicap, loneliness and use of homecare services. Loneliness was itself strongly associated with depression; odds ratio 12.4 (7.6-20.0). CONCLUSIONS: Problems of collinearity, and the cross-sectional design of the study limited interpretation of the exact nature of the relationship between social support, loneliness, handicap and depression. However, the clustering of these four factors can be used to define a large part of the elderly population with a poor quality of life. An important avenue for future research will be the development and implementation of population intervention strategies designed to address some or all of these problems among older people in general.

Aged↗
PubMed1996

Is the cognitive function of older patients affected by antihypertensive treatment? Results from 54 months of the Medical Research Council's trial of hypertension in older adults.

OBJECTIVE: To establish whether initiation of treatment with diuretic or beta blocker is associated over 54 months with change in cognitive function. DESIGN: A cognitive substudy, nested within a randomised, placebo controlled, single blind trial. SETTING: 226 general practices from the Medical Research Council's general practice research framework. SUBJECTS: A subset of 2584 subjects sequentially recruited from among the 4396 participants aged 65-74 in the trial of treatment of hypertension in older adults. The 4396 subjects were randomised to receive diuretic, beta blocker, or placebo. Subjects had mean systolic pressures of 160-209 mm Hg and mean diastolic pressures <115 mm Hg during an eight week run in. OUTCOME MEASURES: The rate of change in paired associate learning test (PALT) and trail making test part A (TMT) scores (administered at entry and at 1, 9, 21, and 54 months) over time. RESULTS: There was no difference in the mean learning test coefficients (rate of change of score over time) between the three treatments: diuretic -0.31 (95% confidence interval -0.23 to -0.39), beta blocker -0.33 (-0.25 to -0.41), placebo -0.30, (-0.24 to -0.36). There was also no difference in the mean trail making coefficients (rate of change in time taken to complete over time) between the three groups: diuretic -2.73 (95% confidence interval -3.57 to -1.88), beta blocker -2.08 (-3.29 to -0.87), placebo -3.01, (-3.69 to -2.32). A less conservative protocol analysis confirmed this negative finding. CONCLUSION: Treating moderate hypertension in older people is unlikely to influence, for better or for worse, subsequent cognitive function.

Adrenergic beta-Antagonists↗
PubMed1990

Treating hypertension in the older person: an evaluation of the association of blood pressure level and its reduction with cognitive performance.

No adverse effect upon cognitive function has been detected during the first 9 months of treatment by a thiazide diuretic (Moduretic; Merck Sharp & Dohme, Hoddesdon, UK) or a beta-blocking agent (atenolol) of moderately elevated blood pressure in a cohort of 2630 men and women aged between 65 and 74 years. Furthermore, no association was discovered between levels of systolic or diastolic blood pressure at outset and responses to standard tests of cognitive function. This study was carried out in general practices as part of the current Medical Research Council Treatment Trial of Mild Hypertension in the Elderly.

Aged↗
PubMed1989

Can a computer reliably elicit an alcohol history?

The drinking histories of 102 patients were elicited by both a computer and a nurse, with 48 of the patients also being interviewed by a psychiatrist. The computer agreed as closely with the nurse and the psychiatrist as they did with each other. For all three, there was better agreement for screening interviews whose questions are dichotomous (i.e. yes/no) than for interval data such as volume of alcohol consumed. Nevertheless, the agreement for alcohol volume was at least as good as that reported in the literature for inter-rater reliability. Thus a computer can interview patients about their drinking habits as accurately as a nurse or a psychiatrist. In many clinical settings computer interviewing might prevent patients with alcohol-related illnesses remaining undetected.

Adolescent↗
PubMed1984

Preliminary findings from a study of the effects of a challenge dose of alcohol in male twins.

Twelve pairs of MZ and 7 of DZ normal adult male twins were given a challenge dose of 0.8 mg ethanol per kg body weight diluted to a 30% v/v solution. Measures of blood alcohol, mood, craving for alcohol, body sway, heart rate and four psychomotor tasks were taken before, during and after intoxication. Genetic factors were found to be involved in the response of heart rate, body sway and two of the psychomotor tasks, but not in changes in blood alcohol, alertness or craving for alcohol. Drinking habits did not exert a strong influence upon acute responses to alcohol, but were significantly related to craving for alcohol whilst intoxicated.

Adult↗
PubMed1984

Altruism and genetics.

Three questionnaires measuring altruistic tendencies were completed by 573 adult twin pairs from the University of London Institute of Psychiatry Volunteer Twin Register. The questionnaires consisted of a 20-item Self-Report Altruism Scale, a 33-item Empathy Scale, and a 16-item Nurturance Scale, all of which had previously been shown to have construct validity. For the three scales, the intra-class correlations for the 296 MZ pairs were 0.53, 0.54, and 0.49, and for the 179 same-sex DZ pairs were 0.25, 020, and 0.14, giving rough estimates of broad heritability of 56%, 68%, and 72%, respectively. Maximum-likelihood model-fitting revealed about 50% of the variance on each scale to be associated with genetic effects, virtually 0% to be due to the twins' common environment, and the remaining 50% to be due to each twins' specific environment and/or error associated with the test.

Adult↗
PubMed1981

Alternatives to drug use: an alternative approach to drug education.

The Alcohol and Drug Education Course, a secondary prevention program for drug-abusing adolescents, was evaluated. The program provided some drug information, but primarily emphasized alternatives to drug and alcohol use for achieving altered states of consciousness. Students were found to be relatively knowledgeable about the effects of drugs, but were also misinformed on some issues. The program was successful in increasing the students' awareness of alternatives to drug use and the hazards of drug abuse, and in decreasing their reported reliance on drugs for achievement of altered states of consciousness.

Adolescent↗