PubMed Health⌕ Search

Biomedical subjects

R D Farmer

Publications and source records attributed to R D Farmer.

15 recordsLinked to original sources
PubMed1992

Suicidal acts on metro systems: an international perspective.

Suicide is a problem experienced by railway networks worldwide. The epidemiology of this method of suicide has not been described in any detail. To investigate the characteristic features of railway suicide, data were gathered from 23 metro systems around the world. The similarities in the nature of this problem across systems were striking. Universally the victims were young (aged less than 40 years); most incidents involved men; case fatality was generally less than 60%; there was no consistent seasonal variation in incidence; the peak time of day for incidents was 1000-1200; proximity to psychiatric institutions was possibly a risk factor. This method of suicide may be prevented by environmental modification of the railway system. Strategies for reducing the opportunities for suicide on railways are discussed.

Adolescent↗
PubMed1991

Ways of telling new parents about their child and his or her mental handicap: a comparison of doctors' and parents' views.

Views about ways of telling parents their child has a mental handicap were collected from a group of parents of children with mental handicaps and a group of doctors with some involvement in this field, using postal questionnaires. Four Likert-type scales were refined covering views about the fullness of information, how early parents should be told, whether parents should be protected from shock and unpleasant information, and who should take a primary role in decision-making. Results indicated that parents were more in favour of being given information about their children's handicaps at an early stage than doctors were, and that they saw themselves as the primary decision-makers in matters to do with their children, whilst doctors were more neutral about this. There were no differences in how parents and doctors felt about the fullness of explanations or about the explicit 'protection' of parents from shock and unpleasant information. The results support the findings of other studies which have stressed parents' wishes to be given as much information as early as possible and to be treated as the people primarily responsible for their child. In addition, a difference between what doctors believe to be the best approach and what parents believe to be the best approach is suggested, and the importance of doctors being given opportunities to learn directly from parents and people with mental handicaps themselves is emphasized.

Adaptation, Psychological↗
PubMed1991

Operative survival and 40 year follow up of surgical repair of aortic coarctation.

OBJECTIVE: To study early and late mortality after surgical correction of coarctation of the aorta. DESIGN: Data on 223 patients operated on at the Westminster Hospital, London, between 1946 and 1981, were collected and updated by questionnaire. PARTICIPANTS: All 223 patients recorded as undergoing operation for aortic coarctation up to the end of 1981. Fifteen of 197 survivors were lost to follow up; most of them were patients from overseas. OUTCOME AND RESULTS: The early mortality (within one month of operation) was 12% overall, 2.6% for elective surgery, and 0% for the 77 patients undergoing surgery since 1968. Survivors were followed up for a total of 3288 patient years; in 27 follow up lasted more than 30 years. In a few it reached 40 years. Twenty two patients died during this period, 18 from causes that could be attributed to coarctation or its repair. Mortality was highest more than 20 years after the operation. CONCLUSION: Repair increased life expectancy in patients with aortic coarctation. Late problems caused by persistent hypertension or recoarctation became apparent in long term survivors. The increased risk of late mortality associated with the duration of preoperative hypertension was not statistically significant. There were no deaths from cerebrovascular accidents. (In an earlier necropsy series cerebrovascular accidents accounted for 11.8% of deaths.) The incidence of deaths from aneurysms resembled that in the earlier necropsy series.

Adolescent↗
PubMed1990

A study of doctors' and parents' attitudes to people with mental handicaps.

The attitudes to people with mental handicaps held by a group of parents of children with mental handicaps and a group of doctors with some involvement in this area were compared using postal questionnaires. Doctors' estimates of how parents would respond were also compared with parents' responses and doctors' own responses. Four Likert-type scales were refined covering attitudes towards the effect on the family, the place in society of people with mental handicaps, their quality of life, and independence and autonomy. Results indicated that parents had more positive attitudes than doctors except with regard to independence and autonomy, to which doctors had the most positive attitudes. Doctors were aware that parents were likely to see the effect on the family in a more positive light, and independence less positively, than themselves. However, they underestimated the degree of positivity of parents about the place of people with mental handicaps in society, and their quality of life, to the extent that they expected parents to be significantly less positive about quality of life than they themselves were, whilst parents in fact proved significantly more positive. The differing perspectives and experiences of parents and doctors are discussed and some suggestions made of ways in which doctors' appreciation of the parental perspective could be developed in an attempt to facilitate sympathetic communication between them.

Adaptation, Psychological↗
PubMed1990

Models for forecasting hospital bed requirements in the acute sector.

STUDY OBJECTIVE: The aim was to evaluate the current approach to forecasting hospital bed requirements. DESIGN: The study was a time series and regression analysis. The time series for mean duration of stay for general surgery in the age group 15-44 years (1969-1982) was used in the evaluation of different methods of forecasting future values of mean duration of stay and its subsequent use in the formation of hospital bed requirements. RESULTS: It has been suggested that the simple trend fitting approach suffers from model specification error and imposes unjustified restrictions on the data. Time series approach (Box-Jenkins method) was shown to be a more appropriate way of modelling the data. CONCLUSION: The simple trend fitting approach is inferior to the time series approach in modelling hospital bed requirements.

Adolescent↗
PubMed1989

Why do fatal overdose rates vary between antidepressants?

Age specific death rates for poisoning with different antidepressant drugs, based on mortality statistics and the numbers of prescriptions dispensed, were calculated for England and Wales 1979-1985. There are marked variations in mortality associated with different drugs; the highest rates are found with amitriptyline and dothiepin whereas the lowest were associated with mianserin and clomipramine. For all drugs considered, the calculated mortality rates for the over 65 year olds, though still substantial, were lower than those in patients under 65 years of age, probably because of a diminished detection rate of poisoning in this older age group. A high proportion of the fatal overdoses implicating amitriptyline and dothiepin involved more than one substance. The rank order of mortality rates from antidepressants was identical in the different age groups. The implications of these findings are discussed. It is concluded that the variations in mortality rates are mostly due to variations in the inherent toxicity of the drugs (particularly their cardiovascular effects) and only in part due to possible differences in compliance. It is suggested that when antidepressant drugs are prescribed, the risk of death from overdose should be taken into account. Tricyclic drugs, particularly amitriptyline, dothiepin, doxepin, trimipramine and maprotiline, should be avoided in patients at risk of suicide, whatever the age of the patient.

Adult↗
PubMed1986

Patterns of use of a mental handicap register in its first 5 years.

After its first 5 years in full operation, the requests for information made to a mental handicap register were examined. It was found that the register had been used extensively by a large number of people requesting a variety of information, both statistical and personal, relating to groups and individuals, and used both to gain an increased understanding of the present situation and to plan for change. Questionnaires sent to those people who had used the register in the first 6 months of 1985 revealed a high level of satisfaction with the register's ability to provide the information they requested. The uses and limitations of the register are discussed.

England↗
PubMed1977

Suicide mortality in Greater London: changes during the past 25 years.

Suicide mortality in the area now administered by the Greater London Council was assessed for three five-year periods 1949-1953, 1959-63, and 1969-73. For each of the periods the standard mortality ratio (SMR) for suicide in various boroughs was calculated for men and women separately. The boroughs with high SMRs for men were constant. There was a pronounced change in the geographical distribution of high mortality among women. These findings support the hypothesis that the determinants of suicide differ between the sexes.

Adolescent↗