Biomedical subjects

S Platt

Publications and source records attributed to S Platt.

At least 19 recordsLinked to original sources

PubMed1998

The psychological autopsy approach to studying suicide: a review of methodological issues.

The psychological autopsy approach to studying suicide is becoming an increasingly used research method. It presents considerable methodological problems. In order to assist future researchers in this field and to help readers assess reports of psychological autopsy studies the authors have reviewed these issues on the basis of their own experience and those of other workers. The areas covered include research design, identification of subjects, sources of information and the particular issues concerned with approaching relatives and other informants, choice and recruitment of controls, the difficulties of conducting psychological autopsy interviews with relatives, problems for interviewers, the selection of appropriate measures to obtain information, and achieving valid and reasonably reliable conclusions from diverse information sources.

Autopsy↗

PubMed1997

Predischarge arrhythmia induction testing of implantable defibrillators may be unnecessary in selected cases.

Complete postoperative evaluation of implantable cardioverter-defibrillators (ICDs) before discharge, including arrhythmia induction, has been the standard since their introduction. Whereas the original ICDs provided little telemetered information and used separate pace-sense and defibrillation leads, modern, third-generation devices provide pace-sense function information in addition to other data and are used in conjunction with integrated transvenous endocardial leads that combine pace-sense and defibrillation function. Changes in lead position, which can potentially result in either an inability to detect fibrillation or to terminate it, should be mirrored by changes in resting pace-sense function. Thus, for newer ICDs implanted with integrated endocardial lead systems, it is possible that in at least some cases predischarge arrhythmia inductions can be avoided. Two hundred patients receiving third-generation ICDs in conjunction with integrated transvenous leads were evaluated before discharge. Defibrillation detection or termination problems were seen in 8. Declines in resting R-wave amplitude and pacing impedance were significantly associated with such complications (-7 +/- 5 vs -0.3 +/- 2.3 mV [p <0.0001] and -158 +/- 138 vs -93 +/- 76 omega [p <0.05], for those with vs without complications, respectively), as were gross right ventricular lead migrations on chest x-ray. No patient with a defibrillation complication had an R-wave change of <3 mV. However, 13% of patients without complications had R-wave changes of >3 mV. It is concluded that a pace-sense evaluation of ICDs may be a satisfactory screen to determine those who need to go on to complete testing with arrhythmia induction in selected cases.

Aged↗

PubMed1997

Effectiveness of antismoking telephone helpline: follow up survey.

OBJECTIVE: To evaluate the effectiveness of an antismoking campaign conducted by the Health Education Board for Scotland. DESIGN: Descriptive survey of adult callers to a telephone helpline (Smokeline) for stopping smoking; panel study of a random sample of adult callers; assessment of changes in prevalence of smoking in Scotland before and after introduction of the helpline. SETTING: Telephone helpline. SUBJECTS: Callers to Smokeline over the initial one year period. Detailed information was collected on a 10% sample (n = 8547). A cohort of adult smokers who called Smokeline (total n = 848) was followed up by telephone interview three weeks, six months, and one year after the initial call. MAIN OUTCOME MEASURES: Numbers of adult smokers calling helpline; changes in smoking behaviour, especially stopping smoking among cohort members; and changes in prevalence of smoking in the general population. RESULTS: An estimated 82782 regular adult smokers made genuine contact with Smokeline over the year, representing about 5.9% of all adult smokers in Scotland. At one year 143 of the cohort of 848 callers (23.6%; 95% confidence interval 20.2% to 27.0%) reported that they had stopped smoking and 534 (88.0%; 85.4% to 90.6%) reported having made some change. About 19500 (16700 to 22350) adult smokers, equivalent to 1.4% (1.2% to 1.6%) of the mean adult smoking population, stopped smoking with direct help from Smokeling. During the second year of the campaign (1994) smoking prevalence among 25-65 year olds in Scotland was 6% (2.0% to 10.0%) lower than it had been before the start of the campaign. CONCLUSION: The Health Education Board for Scotland's antismoking campaign reached a high number of adult smokers, was associated with a highly acceptable quit rate among adults given direct help through Smokeline, and contributed considerably to an accelerated decline in smoking prevalence in Scotland.

Adolescent↗

PubMed1997

Indicators of socioeconomic status for adolescents: the WHO Health Behaviour in School-aged Children Survey.

Many indicators of socioeconomic status used for adults are inappropriate for use in research on adolescents. In a school-based survey of 4079 Scottish schoolchildren using a self-completion questionnaire, over 20% of 11-15 year olds were unable to provide a substantive response on father's occupation. In contrast, indicators derived to construct a family affluence scale, which included car ownership, telephone ownership and the child having their own unshared bedroom, resulted in a 98% response rate; and 92% of children responded to a question on their weekly spending money. The intercorrelations between the conventional indicator of father's occupation and each family affluence and spending money were examined, and their associations with a range of health indicators and health behaviour measures compared. Father's occupational status and family affluence were moderately correlated and showed broadly similar patterns of association with the selected health measures although there were also some distinct differences. Child's spending money was only weakly correlated with father's occupation and showed rather different patterns of association with health measures. A case is made for the use of multiple indicators of socioeconomic status in adolescent health surveys, and it is argued that that the family affluence scale provides a useful and easily applied additional indicator to father's occupation or an alternative measure of socioeconomic background where occupational data are unavailable.

Adolescent↗

PubMed1997

Cost effectiveness of a mass media-led anti-smoking campaign in Scotland.

OBJECTIVE: To evaluate the costs and outcomes associated with the Health Education Board for Scotland's general public anti-smoking campaign during the developmental stage and its first year of operation. DESIGN: Cost information collected retrospectively was combined with prospectively collected effectiveness data. SUBJECTS: A panel of 970 adults were recruited from a 1-in-10 random sample of adult callers to the telephone helpline (Smokeline). Those who smoked were subsequently interviewed at three weeks, six months, and one year follow up. Information on smoking status at one year and time spent as a non-smoker was available for 587 members of the panel. MAIN OUTCOME MEASURES: Intermediate outcomes in the follow-up sample included a point prevalence and period prevalence measure of smoking cessation. Long-term outcomes were measured in terms of predicted reductions in mortality as a consequence of smoking cessation. RESULTS: At the 12-month point, 9.88% of individuals in the follow-up sample reported themselves as non-smokers and as having given up for at least six months in the previous year. Estimates of the cost per life-year saved as a result of the campaign range from 304 pounds sterling to 656 pounds sterling. CONCLUSIONS: Provided that the benefits of smoking cessation are broadly accurate, and the assumed level of quitting can be directly attributed to Smokeline, then this mass media-led anti-smoking campaign appears to have been cost effective.

Adult↗

PubMed1996

Transtelephone monitoring for pacemaker follow-up 1981-1994.

Transtelephone monitoring (TTM) is capable of detecting pacemaker pulse generator malfunction, battery depletion, and lead failure. The accuracy of TTM was analyzed by a review of Montefiore Medical Center records between October 1981 and March 1994. Each group of transmissions from a single patient, starting with implant and ending with a pacemaker operation, was defined as a closed cycle (CLOSE), if undergoing continuing follow-up at the time of analysis, as a continuing cycle (CONT), and if a cycle had ended with death or loss to follow-up, an open cycle (OPEN). TTM records of 2,632 patients were analyzed, providing 3,291 cycles. There were 731 CONT, 433 CLOSE, and 2,127 OPEN cycles; 331 procedures were indicated by TTM, of which 279 were impending depletion, 30 sudden depletion, and 22 lead malfunctions. Of the 102 procedures not indicated by TTM, 85 were for nonurgent reasons (recall: 41; DDD upgrade: 16; patient/MD request: 28) and 17 for urgent reasons. In patients followed by TTM who had a lead problem, 22 were detected by TTM before clinical manifestations and 16 were not. There were no cases in which TTM follow-up did not detect battery depletion. The total number of TTM contacts, available for 3,094 cycles, was 88,654 (range, 1-163, median 19), of which 0.4% yielded a procedure. During the same period, 75% of all secondary interventions during the first 2 years occurred during the first 2 months after implant because of lead malfunction, with a subsequent SI rate of 0.005 per month for the third through the twenty-fourth months.

Electrocardiography↗

PubMed1996

The Chief Scientist reports... Behavioural risk factors for coronary heart disease and cancers among adults in Edinburgh and Glasgow: assessing change 1988-1995.

OBJECTIVE: To assess change over time in selected behavioural risk factors for coronary heart disease and cancers and to assess progress towards government-defined health targets. DESIGN: Computer assisted telephone interview survey, randomly selected sample. SETTING: Edinburgh and Glasgow. SUBJECTS: 34,247 aged 18-60 years; 43.2% male and 56.8% female. MAIN OUTCOME MEASURES: Changes in cigarette smoking, diet, alcohol use and exercise among adults between 1988 and 1995. RESULTS: A majority of the variables under study showed significant change over the time period under review. On the positive side, the percentage of female smokers decreased significantly, whilst the number of female ex-smokers increased; the use of salt and butter declined significantly for men, and butter use declined significantly for women; and increasing numbers of men ate fruit in the last 24 hours and daily. On the negative side, there was no significant decrease in smoking prevalence among men; no significant increase in reported participation in physical activity for exercise for men or women, and a significant decrease in frequency of exercise for women; and the frequency of "drinking heavily on occasion' increased for both men and women. CONCLUSIONS: Significant positive changes in key health behaviours have taken place among adults resident in Edinburgh and Glasgow since 1988, particularly in relation to smoking among women and diet among men, but progress is slow and patchy.

Adult↗

PubMed1995

Background and introduction to the WHO/EURO Multicentre Study on Parasuicide.

In most European countries, suicidal behavior is a major public health problem and a considerable drain on resources at both the primary and secondary health care levels. Unfortunately, due to cross-cultural differences both in medical treatment of nonfatal suicidal behavior and in research methodologies, it has proved almost impossible to make valid comparisons between countries. It is therefore imperative that international studies based on the same definitions and methodologies be facilitated if we want to extend our knowledge of suicidal behavior and be able to make suggestions for intervention and prevention. The WHO Regional Office for Europe decided to support a collaborative multicenter study, designed to provide a reliable epidemiological picture of parasuicide in Europe. This article provides an introduction to the study.

Adolescent↗

PubMed1993

Estimating the population prevalence of injection drug use and infection with human immunodeficiency virus among injection drug users in Glasgow, Scotland.

Although data on the prevalence of injection drug use are an essential prerequisite for estimating the number of individuals infected with the human immunodeficiency virus (HIV), there have been few attempts to utilize statistical methods of population estimation based on multiple data sources. Data on 3,670 cases (2,866 individuals) were obtained from the HIV test register, drug treatment agencies, police records, and needle and syringe exchanges in Glasgow, Scotland, in 1990. Log-linear analysis was used to model the number of individuals in each of the sources. The model incorporating dependency among the three health care agencies (HIV test, drug treatment, and needle exchange) and independence of the police sample fitted the data well, with a residual chi 2 value of 2.9 (6 df). The expected value of the missing cell corresponding to absence from all four samples was 5,628, yielding an overall estimate of 8,494 injectors (95% confidence interval (CI) 7,491-9,721), for a prevalence rate of 1.35% for people aged 15-55 years in Glasgow during 1990. The high ratio of known to unknown injectors (1:2) resulted from the extensive coverage of known injectors and the relatively high level of overlap between the combined health care agency sample and the police sample. While further analysis demonstrated that the probability of appearing in the four samples varied by age and sex, heterogeneity in the population did not affect the choice of model or substantially alter the estimates for the total number of unknown injectors. A concurrent study of a community-wide sample of 503 injectors resulted in an HIV prevalence rate of 1.1% (95% CI 0.4-2.5%). The results of these studies were combined to produce a further estimate of 93 HIV-infected current injectors in Glasgow (95% CI 33-214).

Adolescent↗

PubMed1993

Factors associated with suicide after parasuicide in young people.

OBJECTIVE: To determine factors associated with completed suicide in young parasuicide patients. DESIGN: Case-control study. SETTING: Regional poisoning treatment centre in a teaching general hospital. SUBJECTS: Patients who, between 1968 and 1985 when aged 15-24 years, were admitted to the regional poisoning treatment centre because of deliberate self poisoning or self injury. Cases (n = 62) consisted of those who by the end of 1985 had died locally from either suicide (n = 41) or possible suicide (n = 21). Controls (n = 124) were patients who were known not to have died locally during the study period. Two controls were selected for each case, matched by sex, age (within two years), and length of follow up. MAIN OUTCOME MEASURES: Possible predictors of completed suicide. RESULTS: Univariate analysis (conditional logistic regression) showed that risk of death due to suicide and possible suicide was associated with six factors: social class V (odds ratio 2.7, 95% confidence interval 1.1 to 6.7), unemployment (2.8, 1.4 to 5.8), previous inpatient psychiatric treatment (4.9, 2.2 to 10.9), substance misuse (3.3, 1.6 to 6.8), personality disorder (2.1, 1.03 to 4.4), and previous attempted suicide (2.3, 1.2 to 4.4). Multivariate analysis identified two factors as significantly contributing to the model that best discriminated between the cases and controls: substance misuse (alcohol or drugs, or both) (adjusted odds ratio 3.9) and previous inpatient psychiatric treatment (3.7). These factors seemed to be associated with suicide after attempted suicide in both the short term (less than 12 months) and the long term (one year or more) and were also identified when the analysis was restricted to subjects who definitely died by suicide and their controls. CONCLUSIONS: Suicide after parasuicide in young people is associated with substance misuse. This suggests that prevention of suicide in young people who attempt suicide might be improved by close liaison between general hospital services for patients who have attempted suicide and services for young substance misusers and by measures aimed at preventing substance misuse in young people.

Adolescent↗

PubMed1993

HIV prevalence and HIV risk behaviour among injecting drug users in London and Glasgow.

This paper reports on the British findings from a cross-national study of HIV prevalence and HIV risk behaviour among 1,037 injecting drug users (IDUs) recruited from a variety of treatment- and community-based settings during 1990. Confirmed HIV saliva test results show 12.8% (63) of London respondents and 1.8% (8) of Glasgow respondents to be HIV antibody positive. Among London respondents, a higher rate of prevalence was found in those with no experience of drug treatment. A greater proportion of Glasgow respondents (68%) than London respondents (47%) reported sharing used injecting equipment in the 6 months prior to interview. The majority (88% in both cities) attempted cleaning borrowed equipment, although less than a third (31% in London and 30% in Glasgow) usually used bleach. The majority of respondents (71% in London and 82% in Glasgow) were sexually active with partners of the opposite sex in the last 6 months, and respondents had a mean number of 2.4 non-commercial sexual partners in London and 2.1 in Glasgow. Levels of reported condom use were comparable with reports in the heterosexual population as a whole, with 70% of London respondents and 75% of Glasgow respondents never using condoms with primary partners, and 34% of London and 52% of Glasgow respondents never using condoms with casual partners. Half (48%) of London respondents and 42% of Glasgow respondents reported sexual intercourse with non-injecting private sexual partners, while 14% of female respondents in London and 22% in Glasgow had engaged in prostitution. Levels of risk-taking in each of the two cities indicate the potential for further transmission of HIV among drug injectors, and their sexual and sharing partners.

Adult↗

PubMed1993

HIV risk behaviours among female prostitute drug injectors in Glasgow.

This paper focuses upon HIV-related risk behaviours of 51 female drug injecting prostitutes, interviewed as part of a serial cross-sectional study of injecting drug users in Glasgow. Forty-five per cent injected with used needles and syringes in the 6 months prior to interview. Condom use in private sexual relations was low with only 9% of those with primary partners and 22% of those with casual partners reporting consistent use of condoms with these partners. In contrast, use of condoms for all commercial sexual encounters was almost universal. Prevalence of HIV was 2.2%. Despite this low prevalence, we conclude that the level of injecting-related and private sexual risk behaviours reported here requires the continuing monitoring of drug injecting prostitutes in Glasgow.

Adolescent↗

PubMed1993

Age, parasuicide and problem drinking.

The contribution from genetic loading in a series of male parasuicidal patients with early onset alcohol problem was found to be of less importance than the nurturance factor of separation from father during childhood. Behavioural patterns in this younger onset group were significantly more antisocial than those in the older onset group.

Adult↗

PubMed1993

The social transmission of parasuicide: is there a modeling effect?

This article examines four hypotheses derived from social learning theory about the social transmission of parasuicide. The first of these, that parasuicides will have significantly more prior contact with suicidal behavior than matched general population controls, was tested using the Contact with Suicidal Behavior Schedule. There was a tendency for more controls than parasuicides to report nonintensive contact, although more parasuicides claimed intensive recent contact. Overall, lifetime contact did not differ between groups. The second hypothesis suggested that parasuicides who repeat the act will have significantly more prior contact with suicidal behavior. Support for this was almost wholly lacking. The third and fourth hypotheses concerned the relationship between prior contact and attitudes towards parasuicide (using the Case Vignette Instrument). The bulk of the evidence suggested, contrary to predictions, that more contact was associated with more unfavorable attitudes. It was concluded that empirical support in this study for the existence of a modeling effect in parasuicide was, at best, somewhat weak.

Adolescent↗

PubMed1992

Computer assisted design of a theophylline dosing regimen in acute bronchospasm: serum concentrations and clinical outcome.

The effect of intravenous theophylline on the outcome of inhospital treatment of acute bronchospasm has been assessed, comparing the results achieved by computer-assisted dosing, designed to achieve and maintain a serum theophylline level of 16 micrograms.ml-1 (10 patients) with those of unaided physicians (15 control patients). The outcome measures compared were clinical improvement, peak expiratory flow rate and serum theophylline concentration. Loading doses of theophylline in the control and computer groups were: 167 and 437 mg, respectively. Initial serum theophylline concentrations, measured 20 min after the loading dose, were 13.6 and 17.0 micrograms.ml-1 in the control and computer groups, respectively. In patients who had not received theophylline prior to admission, loading doses and initial concentrations were: 200 mg and 9.4 micrograms.ml-1 in the control group (n = 5) versus 613 mg and 15.7 micrograms.ml-1 in the computer group (n = 4), respectively. During maintenance therapy, serum theophylline concentrations were kept in the therapeutic range (10-20 micrograms.ml-1) throughout 51% and 77% of the hospitalisation period, in the control and computer groups, respectively. There were no differences between the two groups in the rate or extent of clinical improvement or in change in peak expiratory flow rate. The computer assisted theophylline dosing regimen outperformed that of the unaided physicians in achieving and maintaining therapeutic serum theophylline concentrations in acute bronchospasm. There was no correlation between clinical outcome and serum theophylline concentration, but this may have been due to the small sample size and modest difference in serum theophylline between the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗

PubMed1992

Suicide and unemployment in Italy: description, analysis and interpretation of recent trends.

This paper assesses the relationship between suicide and unemployment in Italy during the period 1977-1987, taking into account variations by gender and region. The first objective of the study is to provide descriptive longitudinal and cross-sectional aggregate-level analyses and also trends in individual-level and population risks for suicide in relation to unemployment. Our second objective is to use the Italian data to help discriminate between rival interpretations of the unemployment-suicide link, i.e. the operation of health selection or causal (susceptibility) mechanisms. Evidence for an association between suicide and unemployment among women was not convincing. The annual rate of female unemployment was negatively correlated with the female suicide rate and unrelated to the suicide rate among the unemployed, the relative risk or population attributable risk. Individual-level analyses for each year confirmed that unemployed women were more likely to commit suicide than their employed counterparts, although the overall relative risk was low (1.5) and conference intervals for six of the eleven annual risk ratios included unity (1). Among men, the unemployment rate was positively correlated over time with the suicide rate. However, change in the suicide rate across 18 geographic regions of Italy was unrelated to change in the unemployment rate, a finding which did not appear to be invalidated by a regression to the mean effect. Unemployment was also positively related to the suicide rate among the employed and population attributable risk, but unrelated to the rate among the unemployed or the relative risk. Comparison of suicide rates among the employed and unemployed revealed an excess of suicide among the latter in each year, with an overall relative risk of 3.4. On the basis of this contradictory and inconsistent evidence, we are cautious about offering definitive interpretations concerning the nature of the unemployment-suicide link among men. We conclude by suggesting the need for further individual-level studies using retrospective case-control methods.

Adult↗

PubMed1992

The clinical relevance of electromyopotential oversensing in current unipolar devices.

UNLABELLED: Electromyopotential oversensing of unipolar pacemakers was first appreciated 20 years ago, but its prevalence in present day devices is less well defined. Thirty-four pacemaker patients, only two with symptoms suggestive of oversensing, were evaluated in unipolar settings to assess the frequency of provocation of oversensing in one or, if present, both pacing channels. The sensing threshold of each patient, whenever possible, was recorded as well. RESULTS: Atrial oversensing occurred in 11/18 patients (61%), all at sensitivities in the 0.4-1.0 mV range. Ventricular oversensing was noted in 13/33 patients (39%), with all but one programmed to settings of 1.25 mV or more sensitive (i.e. < 1.25 mV). Twenty six of 26 patients amenable to testing had ventricular sensing thresholds of at least 4.0 mV or more. Of the 15 patients amenable to atrial sensing threshold testing, 4 had a threshold of 1.0 mV or < 1.0 mV, 6 had thresholds between 1.0-2.0 mV, and 5 sensed at settings > 2.0 mV. CONCLUSION: Electromyopotential oversensing remains a relevant issue in current day unipolar pacemakers. Most patients do not describe symptoms related to electromyopotential interference, yet such interference is frequently provoked. Oversensing is common at high sensitivities typically utilized for atrial sensing, but quite unusual at settings necessary for adequate ventricular sensing. Programming unipolar devices to unnecessarily high sensitivities should be avoided or serious consequences may result.

Cardiac Pacing, Artificial↗

PubMed1992

Parasuicide in Europe: the WHO/EURO multicentre study on parasuicide. I. Introduction and preliminary analysis for 1989.

The WHO/EURO multicentre study on parasuicide is a new, coordinated, multinational, European study that covers two broad areas of research: monitoring trends in the epidemiology of parasuicide (epidemiological monitoring study); and follow-up investigations of parasuicide populations, with a view to identifying the social and personal characteristics predictive of future suicidal behaviour (repetition prediction project). This article provides background information on the development and organization of the multicentre study, and presents selected findings from the epidemiological monitoring project, based on a preliminary examination of data collected in 15 centres on parasuicides aged 15 years and over treated in health facilities in defined catchment areas during the year 1989. The overall parasuicide incidence varied considerably across the centres, from a high (event) rate of 414 per 100,000 males in Helsinki to a low of 61 among males in Leiden. The highest female event rate was 595 in Pontoise, and the lowest 95 in Guipuzcoa. The mean event rate across all centres was 167 among males and 222 among females. Parasuicide incidence tended to be elevated among 15- to 34-year-olds, with lowest rates among those aged 55 years and over. With one exception (Helsinki), the female parasuicide rate was higher than the male rate, the F:M ratio ranging from 0.71:1 to 2.15:1, with a median of 1.5:1 (events). Short-term repetition rates (as measured by the event:person ratio) differed between centres, from 1.03 to 1.30 (median = 1.12) among males, and from 1.07 to 1.26 (median = 1.13) among females. Although we warn against generalizing from our findings to make statements about differences in parasuicide between countries, we argue that the differences between centres are valid and should be addressed in further research.

Adolescent↗