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Biomedical subjects

T Pickering

Publications and source records attributed to T Pickering.

At least 19 recordsLinked to original sources
PubMed2001

The case for a hybrid sphygmomanometer.

Mercury sphygomanometers are being banned in many countries, but what will replace them for the routine management of clinic blood pressure is unresolved. The accuracy of the two most widely used alternatives, aneroid and oscillometric devices, is questionable. A proposed alternative is a hybrid sphygomomanometer which is based on the mercury technique, but replaces the mercury column with an electronic transducer and display. It also has the potential to eliminate terminal digit preference.

Algorithms↗
PubMed2000

Identifying male college students' perceived health needs, barriers to seeking help, and recommendations to help men adopt healthier lifestyles.

Seven focus groups at a university campus were formed to identify college men's health concerns, barriers to seeking help, and recommendations to help college men adopt healthier lifestyles. Content analysis was used to identify and organize primary patterns in the focus-group data. Results of the study revealed that the college men were aware that they had important health needs but took little action to address them. The participants identified both physical and emotional health concerns. Alcohol and substance abuse were rated as the most important issues for men. The greatest barrier to seeking services was the men's socialization to be independent and conceal vulnerability. The most frequently mentioned suggestions for helping men adopt healthier lifestyles were offering health classes, providing health information call-in service, and developing a men's center. Implications of the results are discussed.

Adaptation, Psychological↗
PubMed2000

Consensus Conference on Self-blood pressure measurement. Clinical applications and diagnosis.

The present study was aimed at reviewing the medical literature devoted to the clinical applications of self-blood pressure monitoring (SBPM) and at providing some recommendations regarding the use of SBPM for diagnostic purposes. The lack of reliability of conventional blood pressure (BP) measurement is largely related to the extreme variability of BP over time. SBPM provides a large number of readings and can be used to predict the results of repeated clinical measurements. The use of SBPM in the diagnosis of white coat hypertension can be proposed as a screening test: if it gives a positive result (a low home BP), it should be confirmed by ambulatory BP monitoring (ABPM). SBPM could improve patients' compliance with medication. Last, SBPM may be cost-effective for the management of hypertensive patients, by reducing costs of medication, number of clinic visits and costs of cardiovascular morbidity. Compared with ABPM, SBPM seems to have a less value for the initial diagnosis of hypertension and for predicting prognosis. In contrast, it should be of more value for the long term follow-up of patients with white coat hypertension and for the evaluation of treatment efficacy in patients with sustained hypertension. The use of SBPM in diabetic hypertensives, in pregnant women and in the elderly is encouraged, but needs further evaluation.

Blood Pressure Determination↗
PubMed2000

Renal vascular disease: medical management, angioplasty, and stenting.

In the absence of large, prospective, quality randomized trials, there remains tremendous debate concerning the optimal management of patients with renal vascular disease. This debate is compounded by the fact these patients do not represent a homogeneous group; different causes and presentations each carry a different prognosis and potential response to therapy. Therapeutic options include medical management, surgery, or percutaneous approaches (angioplasty or stenting). This review examines the results of observational studies of medical and percutaneous therapies for blood pressure control and preservation of renal function. Generally, in patients with fibromuscular disease, the results of percutaneous management are superior to medical therapy. Although these observational studies are difficult to compare, in patients with atheromatous disease, the results with interventional and medical therapy appear roughly similar. There have been three randomized prospective trials of routine angioplasty versus medical management. These trials show little advantage to interventional therapies in those patients whose blood pressure is well controlled with medication who do not show progression of renal insufficiency during medical management. Based on these data, this review outlines a potential management strategy that relies on an individualized risk benefit assessment.

Angioplasty, Balloon↗
PubMed1999

Cardiovascular pathways: socioeconomic status and stress effects on hypertension and cardiovascular function.

In westernized societies there is a consistent and continuous gradient between the prevalence of cardiovascular disease (including both coronary heart disease and stroke) with SES, such that people from lower SES have more disease. Several studies have examined the roles of the major cardiovascular risk factors for explaining this gradient. There is a strong SES gradient for smoking, which parallels the gradient in disease, but the gradients for hypertension and cholesterol are weak or absent. Central obesity and physical inactivity may also be contributory factors. In the United States there is a strong association between SES and race, and it is suggested that the higher prevalence of hypertension and cardiovascular disease in blacks may be attributed to psychosocial factors, including those related to SES. The possible pathways by which SES affects cardiovascular disease include effects of chronic stress mediated by the brain, differences in lifestyles and behavior patterns, and access to health care. At the present time, the second of these is the strongest candidate; the effects of stress have been little studied.

Cardiovascular Diseases↗
PubMed1997

The effects of occupational stress on blood pressure in men and women.

Human hypertension is the end result of a number of genetic and environmental influences, and typically develops gradually over many years. The sympathetic nervous system appears to play a role in the early stages, with structural changes in the resistance vessels becoming dominant later on. The extent to which increased sympathetic actively may be the result of environmental stress is uncertain. Animal studies have suggested that chronic stress can raise blood pressure. Human epidemiological studies have shown that the prevalence of hypertension is strongly dependent on social and cultural factors. Blood pressure tends to be highest at work, and studies using ambulatory monitoring have shown that occupational stress, measured as job strain, can raise blood pressure in men, but not women. This may be associated with increased left ventricular mass. The diurnal blood pressure pattern in men with high strain jobs shows a persistent elevation throughout the day and night, which is consistent with the hypothesis that job strain is a causal factor in the development of human hypertension.

Blood Pressure↗
PubMed1995

Blood pressure variability and its implications for antihypertensive therapy.

Although it is clear that antihypertensive treatment is beneficial in reducing stroke morbidity and mortality, the results of the major outcome studies show less impact on coronary heart disease. Studies utilizing 24-h blood pressure (BP) monitoring show a positive association between target organ damage and the level of 24-h BP, and with variability in BP, which is an independent determinant of target organ damage. Current understanding of the pathogenesis and pathophysiology of coronary heart disease suggests that optimal antihypertensive treatment should ensure the following: effective 24-h BP control, smooth antihypertensive effect with reduced variability; attenuation of the early morning surge in BP; maintenance of the normal circadian pattern of BP; effective therapeutic coverage in the face of suboptimal compliance; and lack of reflex activation of the sympathetic nervous system. On the basis of our current understanding, this optimum is most likely to be achieved by the use of antihypertensive agents with a long duration of action.

Antihypertensive Agents↗
PubMed1992

Ambulatory blood pressure monitoring: an historical perspective.

Since blood pressure was first measured more than 250 years ago, it has been assumed to be a fluctuating phenomenon, but always it has been determined by static measurements in the physician's office. In the 1940s, self-measurement at home was attempted, and two decades later the first ambulatory blood pressure recording devices were developed. These have since been improved, made more convenient, rendered automatic, and are now available for 24-h measurement during a patient's normal day. It is now increasingly recognized that such measurement is more physiologically valid and more accurate in diagnosing hypertension than clinic measurement. In addition, such monitoring may have special utility in assessing response to treatment.

Ambulatory Care↗
PubMed1992

The patterning of psychological attributes and distress by "job strain" and social support in a sample of working men.

As a test of the "job strain" (job demands-control) model, 297 healthy men aged 30-60 were recruited at eight New York City worksites. The association among job demands and control, social support, and psychological outcomes was tested using both ANCOVA and moderated multiple regression, controlling for demographic variables. The job strain model was supported by various psychological outcome measures, with workers in "active" jobs reporting the highest level of Type A behavior, job involvement, and positive attributional style, workers in "low-strain" jobs reporting the lowest job dissatisfaction and trait anxiety, workers in "passive" jobs reporting the most external locus of control and trait anxiety, and workers in "high-strain" jobs reporting the highest job dissatisfaction. Low social support was associated with greater symptomatology, and a significant three-way interaction (demands x control x support) for job dissatisfaction was observed. While selection of subjects into jobs may partially explain these findings, the results support the hypothesis that working conditions influence psychological attributes and distress.

Adaptation, Psychological↗
PubMed1989

Hypertension in blacks: psychosocial and biological perspectives.

The extraordinarily high rate of hypertension in blacks remains a significant public health issue in most industrialized societies. Research has focused on the investigation of racial differences in biological, nutritional, behavioural and psychological, and social factors in an effort to identify the causes of this high morbidity rate. Thus far, research suggests important racial differences in renal functioning, particularly in sodium metabolism and plasma renin activity, as well as potassium intake and sodium:potassium ratio. Behavioral factors such as anger-coping style and John Henryism, and social factors such as socioeconomic status, socioecological stress, social support, urban-rural residence, and family interaction patterns have also been identified as potential contributors. Finally, emerging research paradigms such as laboratory stress reactivity and 24-h ambulatory monitoring of blood pressure may provide promising leads about the interaction between these effects and hypertension in black populations.

Black or African American↗
PubMed1987

Cardiac rate and rhythm in panic patients.

This study assessed cardiac rate and rhythm by ambulatory monitoring in 23 patients with panic disorder or agoraphobia with panic attacks. The patients had a higher than normal mean daily density of ventricular premature complexes (VPCs), but complex ventricular arrhythmias were uncommon. Heart rate was greater during panic intervals than during asymptomatic periods. The prevalence of arrhythmias within symptomatic intervals was similar during panic, partial panic, and anxiety and was significantly higher than during asymptomatic intervals. However, most panic episodes had no arrhythmias, and arrhythmias during panic intervals were simple VPCs.

Adolescent↗