bluuebunny/crossref_metadata_2025 huggingface dataset:
Psychological Concomitants of Tobacco and Alcohol Use in Young Australian Adults
Authors: WINEFIELD H. R. , WINEFIELD A. H. , TIGGEMANN M. , GOLDNEY R. D.
Published: January 2006

Nineteen‐year‐old subjects in an Australian community sample (N= 1028) reported their tobacco and alcohol use of the previous week, and 598 of them gave similar information 3 years later. The paper examines the demographic (sex, ethnic background, and occupational status) and psychological characteristics (hopelessness, self‐esteem, locus of control, and social alienation) of tobacco and alcohol users and nonusers at the ages of 19 and of 22, and also of subjects who started or stopped consumption of these drugs over the three year period. Smoking at 22, and particularly having started to smoke between 19 and 22, seems to be associated with feelings of demoralization and social alienation, as is relatively heavy drinking. Moderate drinking of alcohol is however normative for the well‐adjusted and socially well‐integrated young adult in this culture. The findings imply a need for rather different health‐promotion messages related to tobacco and to alcohol.
A Multidisciplinary and Team Approach
Authors: SPRATLEY T. A.
Published: January 2006

This paper outlines the context in which I work, and then expresses my beliefs about treatment. The value placed on day care and multi‐disciplinary teamwork is stressed. My treatment philosophy is explained and reference made to the ways we control the therapeutic setting. I argue for some of the more controversial aspects of our therapeutic activities and describe the roles of psychiatrist and psychotherapists in our work. It is hoped that these opinions which are candidly expressed will provoke a constructive debate on how we can all best help these challenging people.
Alcoholism and the ‘New Genetics”
Authors: MULLAN MICHAEL
Published: January 2006

Molecular biology is transforming our view of psychiatry. For the first time methods are becoming available to detect directly the genetic abnormalities leading to psychiatric illness. This article examines the ways in which the new marker technology might bridge the gap between classical genetic knowledge of alcoholism and the precise identification and localization of specific genes implicated in its aetiology.
Efficacy of clonidine, guanfacine and methadone in the rapid detoxification of heroin addicts: a controlled clinical trial
Authors: SAN LUIS , CAMÍ JORDI , PERI JOSÉ M. , MATA ROSA , PORTA MIQUEL
Published: January 2006

The efficacy of clonidine, methadone, and guanfacine in rapid detoxification of heroin inpatients was assessed in a randomized controlled clinical trial. Signs and symptoms of abstinence and of side effects were analysed in 90 heroin addicts successfully completing a 12–day inpatient trial, all patients fit DSM‐III criteria for opioid dependence, the age range being 18 to 36 years. All three drugs were effective in controlling abstinence; however, the course of abstinence was different in the methadone group as compared to the adrenergic agonists, the latter showing limitations in their ability to suppress withdrawal manifestations. While mean number of withdrawal signs and symptoms was significantly tower during days 2 to 5 in the methadone group (p < 0.01), adrenergic agonists were slightly more effective at the end of the trial. Incidence of side effects was closely related to the dose administered. Hypotensive action of adrenergic agonists was more marked in orthostatic position. The present results suggest that methadone is superior to adrenergic agonists. Between these drugs clonidine appears to be less effective than guanfacine in controlling some withdrawal manifestations, and causes more side effects, mainly of cardiovascular nature.
The effect of a needle and syringe exchange on a methadone maintenance unit
Authors: WOLK JAEL , WODAK ALEX , GUINAN JAMES J. , MACASKILL PETRA , SIMPSON JUDY M.
Published: January 2006

In November 1986, a pilot needle and syringe exchange was established in Sydney adjacent to a methadone maintenance unit. A retrospective study was carried out to determine the effect of increasing the availability of sterile needles and syringes on the treatment outcome of the methadone maintenance unit. In this study, an increase in availability of sterile needles and syringes was not found to be associated with an increase in the presence of illicit injectable drugs in the urine specimens of clients of the methadone programme compared to a control methadone unit where there was no known change in needle and syringe availability. This study suggests that an increase in the availability of sterile needles and syringes does not appear to lead to an increase in the frequency of intravenous drug use. The possibility of drug and alcohol treatment centres acting as needle and syringe exchange or distribution outlets therefore requires consideration.
Offspring of parents with drinking problems: drinking and drug‐taking as young adults
Authors: ORFORD JIM , VELLEMAN RICHARD
Published: January 2006

One hundred and seventy 16 to 35 year‐old offspring of parents with drinking problems and 80 comparison young adults were recruited from a variety of clinical and community sources. Each was interviewed at length using a semi‐structured interview and 86% were re‐interviewed one year later. No between‐group differences were found in current quantity of alcohol consumption nor in percentages who had ever used or were currently using illicit or prescribed drugs. However, larger numbers of offspring had commenced alcohol use in their early teens and had used other drugs in their later teens, and more offspring than comparisons were currently using alcohol in a risky way, more were using illicit drugs more than occasionally, and more were heavy smokers. These differences were not great, and gender and source of recruitment (clinical versus community) were equally important predictor variables. Analyses conducted within the offspring group offered no support for hypotheses linking adulthood risk with years of exposure, severity of childhood effects and experiences, maternal as opposed to paternal problems, or problems in the same sex parent. However, some support was found for the importance of having had two parents with drinking problems and having had a drinking parent who often drank at home.
Neurophysiological aspects of smoking behaviour: a neuroelectric perspective
Authors: KNOTT VERNER J.
Published: January 2006

Many of the current neurobiological hypotheses of tobacco smoking concern relationships between nicotine‐induced neurotransmitter alterations‐events at the level of the individual neuron‐and mental behavioural states. Since non‐invasive physiological variables may reflect neural activity more directly than overt indices, neurobiological studies are suggested to be particularly helpful in understanding the intermediate steps between the neuronal effects of smoke/nicotine and behavioural change. The intent of this paper is to offer direction and suggestion regarding electroencephalographic (EEG) and event‐related brain potential (ERP) research into smoke/nicotine effects on mood and performance. Suggested directions revolve around multi‐component measurement strategies and the employment of study designs and test paradigms which may offer a more dynamic and detailed neurobiological view of smoke/nicotine effects on these processes.
Drug testing of athletes
Authors: UZYCH LEO
Published: January 2006

Drug testing policies have been enacted affecting a large number of athletes. Complex, wide‐ranging technical questions are raised by drug testing programs designed for athletes. Issues are also raised concerning the structural elements commonly included in a substance abuse policy affecting athletes. The selection of particular athletes for testing, random drug testing, consent forms, constructing a list of banned substances, the handling, collecting and transporting of testing samples, and selected flaws and limitations affecting the drug testing process are among the topics covered in this article.
Sex, HIV and the injecting drug user
Authors: DONOGHOE MARTIN C.
Published: January 2006

There is considerable evidence that drug injectors are reducing their HIV risk, but changes in syringe sharing behaviour have been greater than those in sexual risk behaviour. This paper reviews the literature on sexual risk behaviour in injecting drug users. It focuses on the major areas of concern: HIV prevalence among drug injectors; sexual risk behaviour; the potential for heterosexual transmission; condom use; sexual risk and women; pregnancy; male homosexual activity and drug use; the effect of drugs on sexual behaviour and prostitution. The paper also considers some of the difficulties in changing sexual risk behaviour and suggests some ways forward for intervention and prevention.
Hypercortisolism after opioid discontinuation in rapid detoxification of heroin addicts
Authors: CAMÍ J. , GILABERT M. , SAN L. , DE LA TORRE R.
Published: January 2006

Long‐term opioid consumption can induce hypoadrenalism through impairment of the hypothalamic‐pituitary‐adrenal axis. Results of the present study showed that, in heroin addicts, saliva cortisol concentrations varied according to the amount of recently consumed heroin and the time elapsed since the last self‐administration. Hypercortisolism was observed either after abrupt withdrawal of heroin or the last dose of methadone. Post‐detoxification hypercortisolism was still present on day 16 after the last opioid consumption, whereas it was not observed in abstinent addicts for a mean period of 4 months. During detoxification treatment, mean AUC8–24 cortisol in saliva of clonidine or guanfacine‐treated patients was significantly higher than that in methadone‐ treated patients. It may be hypothesized that elevated cortisol levels may account for untoward effects of adrenergic agonist therapy which, in turn, may represent an added risk factor for relapse during detoxification. Further studies are necessary to correlate the severity of withdrawal symptoms to cortisol levels in opioid addicts detoxified with α2‐adrenergic agonist substitution.
Who should receive methadone maintenance?
Authors: BELL JAMES , DIGIUSTO EROL , BYTH KAREN
Published: January 2006

The aim of this study was to evaluate the assessment policies of a regional unit established to process requests for entry to several long‐term methadone maintenance programmes. The factors which led staff to reject an applicants request for methadone maintenance were retrospectively analysed from assessment records. Analysis indicated that the decision to reject applicants had been based on the judgement that they were not physically dependent on opioids; other factors favouring rejection included less involvement in crime, youth, and short duration of drug use. Eighty‐four applicants who had either been rejected (n= 58) or failed to complete the assessment (n= 26) were followed. At follow‐up, more than half of the subjects had entered methadone programmes, usually after a long delay. Four subjects had achieved a degree of stable abstinence. The remainder were continuing to use illicit drugs, or were in treatment or prison. Four subjects had died. We conclude that: (I) our criteria for excluding people from treatment were based on the perceived need to keep non‐addicted people from maintenance treatment; and (2) such a policy in practice served to prolong the applicants' illicit drug use and delay their entry to treatment.
Benzodiazepine use and anxiolytic abuse and dependence in treated alcoholics
Authors: ROSS HELEN E.
Published: January 2006

The prevalence and correlates of benzodiazepine use and anxiolytic abuse and dependence are examined in a sample of 427 patients in Toronto, Canada, who met lifetime DSM‐III criteria for alcohol abuse or dependence. The patients were evaluated with the NIMH‐DIS and other standard psychiatric and substance abuse rating scales. Forty per cent were recent users of benzodiazepines and 20% had abused or been dependent upon anxiolytics, including benzodiazepines, during their lifetime. Patients with antisocial personality disorder (ASPD) were at higher risk for an anxiolytic disorder as were women and the unemployed. Recent users of benzodiazepines showed more current psychological distress, depressive symptomatology and more severe substance abuse problems than other patients and were more likely to have a lifetime DSM‐III anxiety disorder. Patients with anxiolytic disorders, even if ASPD was controlled for, showed more psychiatric impairment and drug abuse problems than the remaining patients. Of those with a positive urine screen, 46% did not report using benzodiazepines in the previous week. Nineteen per cent of the patients who did not report benzodiazepine use in the previous week had a positive urine screen and were more likely to be found in the detoxification unit.
A theory‐driven approach to the evaluation of professional training in alcohol abuse
Authors: GORMAN D. M.
Published: January 2006

This paper begins by observing that, to date, evaluations of brief training courses in alcohol abuse for non‐specialist professionals indicate that they have little influence on attitudes and behaviour. The reasons why this is so have not been studied in detail, and such training courses continue to be widely used despite their minimal effects. It is argued that the failure of this field of inquiry to develop beyond this point is due to the fact that, with only a very few exceptions, it has not been informed by theoretical concerns. The research in this area is discussed in terms of the types of models tested and the research designs typically used in evaluations. This is followed by a detailed description of the‘theory driven approach’ to evaluation. It is proposed that the use of such an approach by those concerned with the development and evaluation of training in alcohol abuse for non‐specialists would increase the likelihood of identifying the real effects of such programmes and the processes that mediate their successful implementation. This would result in a more purposeful use of educators’ and evaluators' energies and skills.
Stability and prevalence of drinking among young adults
Authors: HARFORD THOMAS C.
Published: January 2006

This data note draws upon the National Longitudinal Survey (NLS) of Labor Market Experience in Youth beginning at ages 17–24 to describe the stability and prevalence of alcohol use over a 6‐year period up to ages 23–30. Approximately 70% of men and 58% of women maintained their drinking status throughout the study. The onset of current and heavier drinking decreased with increasing age while the offset of current and heavier drinking increased with increasing age. The absence of current drinking was unrelated to age for both men and women as was the presence of heavier drinking among men.
Cigarette smoking cessation and alcohol treatment
Authors: BOBO JANET KAY , DAVIS CAROLE M.
Published: January 2006

Cigarette smoking is common among problem drinkers and recovering alcoholics but most cessation research has not addressed this special population of smokers. Confidential survey data were collected from over 700 alcoholism counselors and medical personnel in residential and outpatient chemical dependency units (CDUs) in Nebraska to identify the quit smoking methods these experts recommend and to assess their personal experiences with smoking cessation. A total of 334 respondents (45% of the group) self‐identified as a recovering alcoholic, 51 (7%) as a problem drinker, and 350 (48%) as having no history of alcohol problems. Over 63% of all respondents were former or current smokers. The most frequently recommended quitting methods for people still in treatment for alcohol problems were relying on a support group (69%), adhering to Alcoholics Anonymous (AA) principles (64%), and quitting “cold turkey” (45%). In an adjusted logistic regression model, quitting “cold turkey” and relying on the principles of AA significantly increased a respondent's odds of personally becoming a successful tobacco quitter. We conclude that many recovering alcoholics and problem drinkers can successfully quit smoking and should be encouraged to use abstinence coping skills learned in alcohol treatment.
Subjective predictions of outcome among alcoholics
Authors: SCHUCKIT MARC A. , SMITH TOM L. , IRWIN MICHAEL
Published: January 2006

This study examines the importance of Subjective Staff Ratings as predictors of the 3‐ and 12‐ month outcomes in 375 male primary alcoholic inpatients. For short–term outcome, while combinations of more usual predictors including two aspects of the pretreatment drinking history, evidence of a stable personal relationship, prior alcoholic hospitalizations, employment status, and posttreatment recovery home placement explained up to 5% of the variance on three measures of short‐term outcome, Subjective Ratings alone explained up to 6%. The combination of Subjective Ratings and objective historical data explained up to 9% of the variance. The data indicate that it is difficult to accurately predict short term outcome among primary alcoholics, that the Subjective Ratings of prognosis by the treatment staff are important predictors of short–term outcome which do not overlap greatly with more traditional predictors, but that these ratings appear to add little to the longer term outcome prediction.
Causal attributions in the explanation of alcohol‐related accidents
Authors: PERNANEN KAI
Published: January 2006

This paper discusses issues related to the cognitive and communicational activity of ascribing a causal role to alcohol use in accidents. It is argued that in addition to the empirical relationships to be explained causal attribution is limited by two other types of empirical contingencies: the cognitive processing of information available for causal attribution, and the representation of this information in language (encoding and decoding as pan of communication). Only the latter two types of restrictions in causal attribution are discussed, since its logical requirements are covered by well known methodological principles. On the linguistic and communicative side, limitations and biases in causal ascription are introduced by (1) the three central concepts (‘alcohol’, ‘cause’, ‘accidents’) due to properties inherent in language; (2) the (often implicit) selection of boundary conditions; (3) heuristic inference rules; and (4) the tendency towards thematic closure in describing and explaining phenomena. It is suggested that social, psychological and interactional causal processes have been overlooked in attributing causal links between alcohol use, hazardous behaviour and accidents.
Alcohol and accidents in Switzerland‐a critical review
Authors: FAHRENKRUG HERMANN , KLINGEMANN HARALD K.‐H.
Published: January 2006

The analysis of alcohol‐related traffic accidents points to a negative relationship between the average amount of alcohol consumed and the percentage of alcohol‐related accidents. The data show that the officially registered problem‐rates among drivers under the influence of alcohol depend primarily neither on consumption trends nor on general preventive factors, but, rather on the capacity for accident detection, the recording practices of the authorities and a less tolerant public opinion. Regional differences in the willingness to enforce control measures are related to varying cultural drinking contexts. The under‐reporting of occupational accidents reflects an undue emphasis in insurance statistics which are based on a guilt/moral concept which is used to justify sanctions, such as cuts in insurance benefits. It is clear from the empirical evidence, that the broad press coverage on ‘alcohol‐related’ ski accidents proves to be a typical case of problem amplification.
Structure and correlates of alcohol dependence in clinical samples in the United States and Russia
Authors: ALLEN JOHN P. , FERTIG JOANNE B. , TOWLE LELAND H. , BRYANT KENDALL , ALTSHULER VLADIMIR B. , VRUBLEVSKY ANDREI G. , VALENTIK YURI V.
Published: January 2006

Using items from the Composite International Diagnostic Interview, dimensionality of the alcohol dependence syndrome was assessed in clinical samples in the United States and Russia. In both groups, a single‐factor model provided a high degree of goodness of fit thus demonstrating cross‐cultural coherence of the construct. The item dealing with narrowing of the drinking repertoire is most disparate in each sample. Seventy of alcohol consequences was moderately related to alcohol dependence in both samples. Demographic variables, however, correlated less with severity of consequences. After the effects of severity of dependence and demographics were removed, quantity/frequency of recent alcohol consumption did not contribute to severity of consequences. Country, however, remained a significant, but small, predictor of severity of alcohol consequences.
Research in general practice for smokers and excessive drinkers in Australia and the UK. II. Representativeness of the results
Authors: RICHMOND ROBYN L. , ANDERSON PETER
Published: January 2006

This paper reviews some of the issues related to the appropriateness of generalizing the results from clinical trials which have been conducted in genera] practice for smokers and excessive drinkers. We discuss the representativeness of the results related to the method of recruitment of general practices and patients to the study populations. We examine methodological issues and reasons associated with general practitioners’ and patients’ non‐compliance with maintaining the research protocols and intervention requirements which relate to the practice worthiness and the future uptake of interventions. When assessing the applicability of interventions to general practice, there are three basic research questions which should be looked at quite separately that relate to: efficacy, effectiveness and implementation.
Cross‐national studies of AIDS among injecting drug users
Authors: JARLAIS DON C. DES
Published: January 2006

HIV infection among injecting drug users has become a world‐wide public health problem. This raises fundamental questions about the modifiability of drug‐using behavior and of the influence of different national settings upon the modification of drug use behavior. Data from the World Health Organization Multi‐site Study of HIV and Injecting Drug Use and studies of HIV among drug injectors in New York City (the US component of the WHO study) are used to address these questions. There is no clear relationship between HIV seroprevalence and current levels of risk behavior in the WHO cities, and the range in seroprevalence is much greater than the range in current risk behavior. Nonetheless, historical trend data enable us to discern at least two broad patterns in different cities. HIV epidemics appear to have been successfully prevented among IDUs in some cities, in that seroprevalence has remained low and stable over several years. These cities are characterized by community outreach programs and good access to sterile injection equipment. On the other hand, high‐servoprevalence epidemics have also occurred in many different cities. Stabilization of seroprevalence has eventually also occurred in these cities, but this still includes moderate rates of new HIV infections. How to reverse high‐seroprevalence situations remains one of the more difficult questions in HIV epidemiology. The epidemiology of HIV infection among injecting drug users also needs to include analyses of the impacts of decisions by political and public health leaders. A three‐category scheme for classifying political decisions is offered: data‐free decisions, data‐based decisions, and data‐proof decisions.
Validity of the bi‐axial dependence concept: a test in the US general population
Authors: HASIN DEBORAH S. , MUTHUEN BENGT , WISNICKI KATHLEEN S. , GRANT BRIDGET
Published: January 2006

According to the “bi‐axial” concept of alcohol dependence, the Alcohol Dependence Syndrome (ADS) constitutes an axis or dimension of alcohol difficulties, while other alcohol‐related problems (social, legal, etc.) constitute one or more separate dimensions. The validity of the bi‐axial distinction was investigated in a stratified probability sample of 3212 US current drinkers who were interviewed in their households. Indicators of the Alcohol Dependence Syndrome and potentially distinct alcohol‐related problems were covered in a structured interview administered by carefully trained interviewers. This interview provided extensive coverage of drinking patterns and problems. Aspects of the ADS covered included narrowing, salience, tolerance, withdrawal, withdrawal relief/avoidance and compulsion/control. Other alcohol problems included difficulties with work, health, the law, general social difficulties and problems in marriage/home life. Confirmatory and exploratory factor analyses were used to determine whether a single factor (dimension) or two or more factors fit the data best. Using all methods, we found that one general factor explained the structure of the data better than a two‐factor model or other models for males, females, blacks and whites. Thus, the utility of this approach to distinguishing between types of alcohol problems was challenged, raising some questions about abuse/dependence distinctions in various nomenclatures.
Koro following cannabis smoking: two case reports
Authors: CHOWDHURY ARABINDA N. , BERA NIRMAL K.
Published: January 2006

Koro in the background of drug abuse is quite rare. The present report of Koro during the first experience with cannabis is the only account of its kind in the world Koro literature to date. The nature and extent of this genital depersonalization is discussed.
Young and recent‐onset injecting drug users are at higher risk for HIV
Authors: FENNEMA JOHAN S. A. , VAN AMEIJDEN ERIK J. C. , VAN DEN HOEK ANNEKE , COUTINHO ROEL A.
Published: January 2006

Aims. To determine whether young or recent‐onset injecting drug users (IDUs) are at increased risk of HIV infection, and to compare trends in risk behaviours and HIV incidence among subgroups of IDUs. Design. Associations of age and onset of injecting with HIV prevalence and injecting risk behaviours were determined among current IDUs who entered an Amsterdam cohort between 1989 and 1995, and compared with current IDUs recruited in two street surveys in 1990 and 1993. In the cohort, trends from 1986 through 1995 in injecting risk behaviour (as reported at entry) and in HIV seroconversion (among current IDUs during follow‐up) were determined using logistic and Poisson regression. Findings. Sizable portions of IDUs were young (≤ 25 years: 14–30%) or had recently started injecting (within the last 3 years: 17–21%). Between 37% and 50% of young IDUs recently started injecting. HIV prevalence was 12–24% among young IDUs, and 5–12% among recent‐onset IDUs. Young IDUs more often reported current borrowing than older IDUs. Borrowing declined significantly in all subgroups, except young IDUs. The crude HIV incidence declined from 18/100 person‐years (PY) in 1986 to 5/100 PY in 1995. Trends in HIV incidence were not significantly different for subgroups of age or onset of injecting. In a multivariate analysis, recent onset of injecting was an independent predictor (p = 0.04) for HIV seroconversion, but age was not (p = 0.68). Conclusions. Important proportions of drug users are young or have recently started injecting. HIV prevalence is relatively high among young and recent‐onset IDUs. Recent onset of injection is an independent predictor for HIV seroconversion. Our observations may be explained by non‐random patterns of borrowing used needles/syringes. Recent‐onset IDUs should be approached more actively for HIV counselling and testing.
Measurement properties of quantitative urine benzoylecgonine in clinical trials research
Authors: DELUCCHI KEVIN L. , JONES REESE T. , BATKI STEVEN L.
Published: January 2006

Psychometric data are presented which examine the validity of using the concentration of benzoylecgonine in urine, a major metabolite of cocaine, as a measure of drug use, in studies of drug abuse treatments. In such research the standard biological indicator of drug use is usually a qualitative urine drug test, which merely indicates the presence or absence of a drug or its metabolite. A quantitative (i.e. continuous) outcome measure, such as the concentration of a drug or its metabolite in a biological fluid, has substantially more statistical power than a dichotomous measure and should, therefore, prove a more sensitive measure of drug use when viewed from a measurement perspective. Data from two placebo‐controlled clinical trials of fluoxetine as an adjunct to treatment for cocaine abuse are analyzed to address this issue. Results indicate that urine benzoylecgonine level is closely related to self‐reports of drug use and is independent of levels of anxiety, depression and hopelessness.
Educational approaches
Authors: MONTONEN MARJATTA
Published: January 2006

Three papers were presented in the session focusing on educational approaches: Ann Narusk reported on an Estonian study on the influence of the family on adolescents' substance use, Bernadette Roussille presented a French mass media campaign aimed at reducing heavy drinking by young people, and Sally Casswell analysed the public discourse on alcohol, which is an important pan of the social and political context in which decisions are taken about public policies. Each of the papers highlighted in its own way the complex relationships between people's behaviour, its social and cultural context, and the wider economic and political environment.
Pharmacokinetics and tolerability of lamotrigine and olanzapine coadministered to healthy subjects
Authors: Sidhu Jagdev , Job Sarah , Bullman Jonathan , Francis Emma , Abbott Richard , Ascher John , Theis Jochen G. W.
Published: January 2006

Aim

To assess the pharmacokinetic effect and tolerability of lamotrigine 200 mg day−1 and olanzapine 15 mg day−1 coadministration in healthy male volunteers.

Methods

Subjects were randomized to receive either lamotrigine titrated on days 1–42 with olanzapine added on days 43–56 (LTG + OLZ group; N = 16), lamotrigine titration with placebo added on days 43–56 (LTG group; N = 12), or placebo on days 1–42 with olanzapine added on days 43–56 (OLZ group; N = 16). Steady state (0–24 h) pharmacokinetic profiles were determined on day 56 in each group.

Results

The average (90% confidence interval) ratios of lamotrigine area under the concentration–time curve from 0 to 24 h and maximum observed concentration for the comparison of LTG + OLZ:LTG were 0.76 (0.65, 0.90) and 0.80 (0.71, 0.90), respectively. Olanzapine pharmacokinetics were essentially unaffected by lamotrigine. The most frequently reported adverse events (AEs) during combination therapy were fatigue, dizziness and mild transaminase elevations. These AEs occurred at similar frequencies in the LTG + OLZ and OLZ cohorts, while being less frequent or absent in the LTG group.

Conclusions

Lamotrigine and olanzapine coadministration in patients who may benefit from the combination was supported by this study. Lamotrigine dosing schedules are recommended to remain unchanged when combined with olanzapine therapy. However, the possibility exists that the lamotrigine dose for some patients may need adjustment to optimize treatment when olanzapine is added to or withdrawn from a regimen including lamotrigine.
Support for family carers of children and young people with developmental disabilities and challenging behaviour
Authors: McGill P. , Papachristoforou E. , Cooper V.
Published: January 2006

Background  This study gathered information about perceptions of family carers of children and young people with developmental disabilities and challenging behaviour of the help, support and treatment received from services and professionals.

Methods  A total of 66 family carers completed postal questionnaires on the nature of, and their satisfaction with, services, professional help and advice received in respect of their family member's challenging behaviour.

Results  Most carers were dissatisfied with support and services received. Almost half reported receiving no professional input or none that was helpful. Over two‐thirds reported receiving respite care but, in a third of these, the child had been excluded because of challenging behaviour.

Conclusions  Families of children with challenging behaviour often do not receive services and supports that they find helpful. Treatments provided are not always evidence based. The ‘rationing’ of services creates a danger of inequality of access. We need a more proactive approach to identifying and meeting the need for family support.
Discussion groups with parents of children with cerebral palsy in Europe designed to assist development of a relevant measure of environment
Authors: McManus V. , Michelsen S. I. , Parkinson K. , Colver A. , Beckung E. , Pez O. , Caravale B.
Published: January 2006

Background  An instrument to measure environmental factors relevant to physically impaired children is being developed in a European context. Preliminary work in England had identified some potentially important themes. Further inquiry was needed to identify issues important in other European countries.

Objective  To inform the content of a questionnaire relevant to the environment of children with cerebral palsy (CP) living in Europe.

Design  A qualitative study using discussion groups.

Participants  Parents of 28 children with CP from five countries; Denmark, France, Italy, Ireland and Sweden. One discussion group was held in each country with an average of seven parents per group.

Results  The four themes identified in the preliminary work done in England were strongly confirmed across Europe – namely: Mobility, Transport, Support by and to parents, and Attitudes of individuals and institutions towards children. Two new themes identified in the discussion groups were Bureaucracy and Access to information about rights and entitlements.

Conclusions  The environmental factors that cause concern to parents of children with CP are similar across Europe. A prototype environmental questionnaire has been developed based on these findings. The environmental questionnaire is in use in a study in nine European centres.
The enduring effects of abuse and related adverse experiences in childhood. A convergence of evidence from neurobiology and epidemiology
Authors: Reading Richard
Published: January 2006

.
 
Anda R.F.,
Felitti V.J.,
Bremner J.D.,
Walker J.D.,
Whitfield C.,
Perry B.D.,
Dube S.R. &
Giles W.H.
(
2005
)

,
ePub, posted online 29 November 2005
.

Background  Childhood maltreatment has been linked to a variety of changes in brain structure and function and stress–responsive neurobiological systems. Epidemiological studies have documented the impact of childhood maltreatment on health and emotional well‐being.

Methods  After a brief review of the neurobiology of childhood trauma, we use the Adverse Childhood Experiences (ACE) Study as an epidemiological ‘case example’ of the convergence between epidemiological and neurobiological evidence of the effects of childhood trauma. The ACE Study included 17 337 adult HMO (Health Maintenance Organization) members and assessed eight adverse childhood experiences (ACEs) including abuse, witnessing domestic violence, and serious household dysfunction. We used the number of ACEs (ACE score) as a measure of cumulative childhood stress and hypothesized a ‘dose–response’ relationship of the ACE score to 18 selected outcomes and to the total number of these outcomes (comorbidity).

Results  Based upon logistic regression analysis, the risk of every outcome in the affective, somatic, substance abuse, memory, sexual, and aggression‐related domains increased in a graded fashion as the ACE score increased (P < 0.001). The mean number of comorbid outcomes tripled across the range of the ACE score.

Conclusions  The graded relationship of the ACE score to 18 different outcomes in multiple domains theoretically parallels the cumulative exposure of the developing brain to the stress response with resulting impairment in multiple brain structures and functions.
Associations between water chemistry and fish community composition: a comparison between isolated and connected lakes in northern Sweden
Authors: ÖHMAN JOHANNA , BUFFAM ISHI , ENGLUND GÖRAN , BLOM ANDREAS , LINDGREN EMMA , LAUDON HJALMAR
Published: January 2006

1. The correlation between water chemistry, physical variables and fish community composition was examined in 40 small (≤30 ha) coastal lakes in northern Sweden. Twenty of the 40 lakes were isolated from other water bodies and 20 were connected to the Baltic Sea. Lakes were fished in summer, using three different methods. Water chemistry was sampled in late winter prior to ice‐out and pH was measured additionally in summer.

2. Our central question was whether water chemistry plays a greater role in the composition of fish communities in isolated lakes than in connected lakes, as isolated lakes cannot be recolonised once a species has become extinct.

3. Results indicate that winter anoxia affects community composition only in isolated lakes, whereas acidity is of importance in both connected and isolated lakes. Methane (indicating anoxia), was significantly correlated with variation in fish community composition in isolated lakes, and a group of variables that indicate anoxia (CH4, pCO2, inorganic carbon and dissolved oxygen) explained 24–34% of the variation. pH alone explained 12% of the variation in community composition for connected lakes and a group of variables indicating acidity (summer and winter pH and ANC) explained 10–20% of the variation in isolated lakes. Lake area was the most important physical variable, being significantly correlated with the variation in fish community composition in connected lakes.

4. In isolated lakes, the presence of pike (Esox lucius), perch (Perca fluviatilis) and roach (Rutilus rutilus) was associated with low CH4. The occurrence of crucian carp (Carassius carassius) and roach was positively correlated with pH, and the crucian carp was apparently also affected by predation by pike and perch. In connected lakes the effect of anoxia was low, probably due to the possibility of recolonisation and pockets of oxygenated water, allowing pike and perch to persist and thereby limiting the distribution of crucian carp.
Contrasting hybridization rates between sympatric three‐spined sticklebacks highlight the fragility of reproductive barriers between evolutionarily young species
Authors: GOW JENNIFER L. , PEICHEL CATHERINE L. , TAYLOR ERIC B.
Published: January 2006

Three‐spined sticklebacks (Gasterosteus aculeatus) are a powerful evolutionary model system due to the rapid and repeated phenotypic divergence of freshwater forms from a marine ancestor throughout the Northern Hemisphere. Many of these recently derived populations are found in overlapping habitats, yet are reproductively isolated from each other. This scenario provides excellent opportunities to investigate the mechanisms driving speciation in natural populations. Genetically distinguishing between such recently derived species, however, can create difficulties in exploring the ecological and genetic factors defining species boundaries, an essential component to our understanding of speciation. We overcame these limitations and increased the power of analyses by selecting highly discriminatory markers from the battery of genetic markers now available. Using species diagnostic molecular profiles, we quantified levels of hybridization and introgression within three sympatric species pairs of three‐spined stickleback. Sticklebacks within Priest and Paxton lakes exhibit a low level of natural hybridization and provide support for the role of reinforcement in maintaining distinct species in sympatry. In contrast, our study provides further evidence for a continued breakdown of the Enos Lake species pair into a hybrid swarm, with biased introgression of the ‘limnetic’ species into that of the ‘benthic’; a situation that highlights the delicate balance between persistence and breakdown of reproductive barriers between young species. A similar strategy utilizing the stickleback microsatellite resource can also be applied to answer an array of biological questions in other species’ pair systems in this geographically widespread and phenotypically diverse model organism.
Transformation of debris flows into turbidity currents: mechanisms inferred from laboratory experiments
Authors: FELIX M. , PEAKALL J.
Published: January 2006

Three sets of lock exchange experiments were run to look at the generation of turbidity currents from debris flows. The flows ranged from reasonably dilute (4% volumetric concentration) to dense (40% volumetric concentration) with cohesive, non‐cohesive and mixed cohesive/non‐cohesive sediment. Concentration was measured at one height using an Ultrasonic High Concentration Meter. Velocity was measured using Ultrasonic Doppler Velocimetry Profiling at 10 different heights in each run. The resulting flows range from plug flows to well mixed flows. Comparison of the concentration profiles, velocity time–height plots and vertical profiles of downstream velocity and root mean square velocity showed several different transformation mechanisms. Depending on the concentration and composition of the flow, transformation took place through one or more of the following processes: erosion of material from the dense mass, breaking apart of the dense underflow, breaking of internal waves and turbulent mixing. The extent of transformation depends on the viscosity and density of the flow. Initially very dense and viscous flows experience minor transformation only at the surface, resulting in a dilute turbidity current. Flows that are initially not so dense and viscous are churned up entirely, undergoing the different transformation processes. For these flows, transformation processes work throughout the entire flow, not just at the surface. Transformation of the less‐dense flows is efficient with all or most material ending up in the resulting turbidity current.
What is a health expectation? Developing a pragmatic conceptual model from psychological theory
Authors: Janzen Jennifer Amy , Silvius James , Jacobs Sarah , Slaughter Susan , Dalziel William , Drummond Neil
Published: January 2006

Introduction Examination of the existing literature in respect of health expectations revealed both ambiguity in relation to terminology, and relatively little work in respect of how abstract theories of expectancy in the psychological literature might be used in empirical research into the influence of expectations on attitudes and behaviours in the real world. This paper presents a conceptual model for the development of health expectations with specific reference to Alzheimer's disease.

Method Literature review, synthesis and conceptual model development, illustrated by the case of a person with newly diagnosed, early‐stage Alzheimer's disease, and her caregiver.

Outcome Our model envisages the development of a health expectation as incorporating several longitudinal phases (precipitating phenomenon, prior understanding, cognitive processing, expectation formulation, outcome, post‐outcome cognitive processing).

Conclusion Expectations are a highly important but still relatively poorly understood phenomenon in relation to the experience of health and health care. We suggest a pragmatic conceptual model designed to clarify the process of expectation development, in order to inform future research into the measurement of health expectations and to enhance our understanding of the influence of expectations on health behaviours and attitudes.
Patients’ perceptions of joint teleconsultations: a qualitative evaluation
Authors: Harrison Robert , MacFarlane Anne , Murray Elizabeth , Wallace Paul
Published: January 2006

Objective  To determine patient perceptions of joint teleconsultations (JTC), with particular reference to reasons underlying, and factors contributing to, patient satisfaction and dissatisfaction with this mode of health delivery.

Background  Telemedicine has been welcomed as one way of improving health‐care delivery, by improving patient access to secondary care and specialist services hence widening patient choice, particularly for patients outside major conurbations. However, a recent systematic review found currently available data on patient satisfaction with telemedicine to be methodologically flawed. Qualitative evaluations offer the opportunity to elucidate the details of patient satisfaction with this mode of health‐care delivery.

Design  Qualitative study using semi‐structured interviews.

Setting and participants  Purposive sample of 28 participants of a major randomized controlled trial (Virtual Outreach study) of JTC conducted in one urban and one rural area in Britain.

Intervention  Joint teleconferenced consultations with the patient, patient's general practitioner (GP), and a hospital specialist. The patient and GP were sited in the local practice, while the hospital specialist was in the hospital outpatient department, and the two parties were connected by an ISDN2 link and video‐conferencing software.

Main outcome measures  Patient experiences of JTC, with particular reference to reasons underlying, and factors contributing to, overall satisfaction or dissatisfaction.

Results  Two major themes were identified: customer care and doctor–patient interaction. Patients appreciated the customer care aspects of JTC, particularly the enhanced convenience, reduced costs and improved punctuality associated with JTC. However, there were divergent views about the doctor–patient interactions with some patients expressing a sense of alienation arising from the use of technology, and problems with doctor–patient communication.

Conclusions  These data add significantly to the existing literature on patient satisfaction with telemedicine, by elucidating the factors underlying overall satisfaction scores and hence have implications for future service delivery and implementation of telemedicine.
Evolutionary responses of natives to introduced species: what do introductions tell us about natural communities?
Authors: Strauss Sharon Y. , Lau Jennifer A. , Carroll Scott P.
Published: January 2006

Biological invasions dramatically affect the distribution, abundance and reproduction of many native species. Because of these ecological effects, exotic species can also influence the evolution of natives exposed to novel interactions with invaders. Evolutionary changes in natives in response to selection from exotics are usually overlooked, yet common responses include altered anti‐predator defenses, changes in the spectrum of resources and habitats used, and other adaptations that allow native populations to persist in invaded areas. Whether a native population is capable of responding evolutionarily to selection from invaders will depend on the demographic impact of the invader, the genetic architecture and genetic variability of the native population and potentially the history of previous invasions. In some cases, natives will fail to evolve or otherwise adapt, and local or global extinction will result. In other cases, adaptive change in natives may diminish impacts of invaders and potentially promote coexistence between invaders and natives. Here, we review the evidence for evolutionary responses of native species to novel community members. We also discuss how the effects of introduced species may differ from those caused by natural range expansions of native species. Notably, introduced species may come from remote biotas with no previous evolutionary history with the native community. In addition, the rate of addition of introduced species into communities is much greater than all but the most extreme cases of historical biotic exchange. Understanding the evolutionary component of exotic/native species interactions is critical to recognizing the long‐term impacts of biological invasions, and to understanding the role of evolutionary processes in the assembly and dynamics of natural communities.