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Biomedical subjects

R W Turner

Publications and source records attributed to R W Turner.

11 recordsLinked to original sources

Vegan diet and health.

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Attitude of Health Personnel

Behavioral treatment for depression: an evaluation of therapeutic components.

Designed study to determine the "active ingredients" in Lewinsohn's behavioral treatment for depression. Fifty-six men and women were screened for significant depression and were assigned to four experimental treatment groups: (1) an activities-increase group instructed to increment participation in reinforcing activities; (2) an expectancy-control group that participated in a fitness program; (3) a self-monitoring control that simply recorded activities and mood daily; and (4) an attention-control group. Consistent with an operant model of depression, the resulted indicated that increases in activities that Ss had rated as pleasureable alleviated depressed mood over a 30--day time period. While all Ss evidenced some improvement in mood, the activities-increase group showed significantly greater improvement than Ss in groups that did not increase their activity levels. Correlational analyses of daily activity and Depression Adjective Check List Scores proved additional support for the behavioral model of depression. The outcome for the four experimental groups was not different on a measure of belief in internal vs. external control of reinforcement.

Activities of Daily Living

Urgent care in the HMO: evolution of a system in Washington, D.C.

In 1961, Group Health Association, a large, non-hospital based, prepaid group practice in Washington, D.C. established an after-hours walk-in clinic on its premises for the care of medical problems requiring prompt attention. Within a year, this clinic's operation was extended to daytime hours for the use of the consumer-member at his own discretion. After 10 years, in the plan's main health center, the volume of adult visits to the acute care/walk-in center exceeded the number seen in the Department of Internal Medicine; most were of a routine rather than urgent nature. More visits to the acute care service were made during the day, when the full range of ambulatory services were available by appointment, than were made after hours. The choic of immediate first-come, first-served care over the conventional care-by-appointment by so many members was felt to have resulted in discontinuous suboptimal care, segregation of the membership along socioeconomic lines, as well as unnecessary and very costly duplications of service. The background of organizational behavior and community medical practices contribuing to this pattern of utilization are explored. Compared to traditional fee-for-service medicine, demands for outpatient services in the HMO tend to be greater. Acceptable alternatives to off-line channeling of patients with unexpected or acute conditions can be designed. In the general community today, utilization of medical services is strongly influenced by imbalances in available resources and by financial factors which are under no central control. In the HMO, all costs are prepaid and services are planned for a membership of known size. Even so, consumers' use of services in prepaid plans tends to follow the patterns seen in the community. More appropriate distribution of demands requires an active and ongoing system of patient education. A commitment by the HMO's providers and managers toward this goal is indispensable.

Ambulatory Care

Perspectives in coronary prevention.

The seeds of premature coronary heart disease are often sown in childhood and it is the developing arteries of children which are the most susceptible. Paediatricians and all who work with them have the earliest and most promising opportunities for prevention. Coronary protection can be added to the potential advantages of breast feeding and to ensure appropriate fatty acid balance throughout weaning. It is reasonable to accept the strong consensus of opinion on diet reflected in the reports of the eighteen national committees. They are: to reduce total fat intake to 30-35% of the energy, to restrict consumption of saturated fat, cholesterol, sugar, and salt, to increase unrefined carbohydrate and polyunsaturated fat, and to maintain a P/S balance of 1.0-1.5:1. Food is the fundamental coronary risk factor, but others may add insult to injury. Smoking, hypertension, obesity, lack of exercise, and stress, each of which is related to behaviour, may start in childhood. Smoking doubles the overall risk CHD and increases it ten times in males under 45 years old. Good habits, including food preferences and eating patterns learned early, are those most likely to be continued. School meals require and should match revised nutritional education. The co-operation of the food industry is essential and can be anticipated, but it requires a clear lead by paediatricians. The nutritional advice should come from the medical profession. Every contact with children and their parents provides an opportunity for enquiry and giving advice.

Arteriosclerosis

Experience with Devine-Horton dermal patch graft for Peyronie's disease.

Peyronie's disease is a malady frequently seen by the urologist. Many conservative treatment modalities have yeilded successful alleviation of symptoms in a significant number of these patients. A number, however, do not respond and are left with penile curvature and pain on erection such that intercourse is severely impaired. Devine and Horton have proposed resection of the plaque with replacement of the defect with a full-thickness dermal graft. They reported excellent results with minimal complications. Five patients were treated by this technique with successful penile straightening and alleviation of pain. To date, follow-up results have been gratifying, and the Devine-Horton dermal graft technique is suggested for use in treatment of patients with disabling Peyronie's disease.

Aged

2-Aryloxymethyl-2,3,5,6-tetrahydro-1,4-oxazines, a new class of antidepressants.

Some 2-aryloxymethyl-2,3,5,6-tetrahydro-1,4-oxazines have been shown to possess marked antidepressant activity. The 1,4-oxazines were synthesized by lithium aluminum hydride reduction of the readily available 6-aryloxymethyl-2,3,5,6-tetrahydro-1,4-oxazin-3-ones. High antidepressant activity was associated with ortho substitution of the 2-phenoxymethyl group and with 1,4-oxazines devoid of 4-substituents.

Animals