The Role of Alcohol-dependent Self-statements on Drinking Behaviour in a Public Bar

Recent literature suggests that cognitions play a role in drinking behaviour. However, disagreement exists regarding which type of cognition is associated with drinking. This study tested the prediction of a positive relationship between alcohol-dependent self-statements and alcohol consumption in a public bar. Ten heavy, 10 light, and 10 non-drinkers were administered the modified Alcohol Self-statements Questionnaire which contains sets of alcohol-dependent and alcohol non-dependent self-statements as well as factual and emotive self-statements. Their self-talk during drinking zvas also tape-recorded and analysed. Subjects were tested half an hour before, and immediately before the commencement of drinking, and at 10-minute intervals for the first half-hour of a normal drinking session in a public bar. Each session lasted approximately one hour. The results revealed that heavy drinkers showed more alcohol-dependent self-statements than light drinkers who in turn showed significantly more alcohol-dependent self-statements than non-drinkers. No significant differences between the groups were found on the factual or emotive self-statements. Alcohol consumption during the testing period was significantly related to alcohol-dependent self-statements. The result of findings suggest (i) that alcohol-related cognitions are associated with drinking behaviour and are relatively stable during drinking sessions, and (H) that there is a need for greater specificity in the definition of cognition in relation to a problem behaviour, in this case drinking behaviour.     

Drivers' differential perceptions of legal and safe driving consumption

UK drink-drive countermeasures have been grounded in deterrence theory and more specifically through per se legislation. Education and information campaigns to stimulate inhibitory behavioural systems have emphasized the legal limit in terms of “driving safeness”. This study examined the relationship between subjective perceptions of safe driving and legal driving consumption limits and other factors important in the decision to drive after drinking. Responses from over 900 drivers established that those who perceived safe consumption levels to be greater than that required to break the law indicated reduced moral commitment to present and possible future countermeasures. These drivers also had previous experience of being breath tested (but not charged with a drink-driving offence), reported comparatively lower estimates of their chances of apprehension and accident involvement when over the legal limit, showed higher consumption levels on a driving trip and greater self-reported driving while impaired by alcohol. The implications of the findings for the development and delivery of measures to counter drink-driving are discussed.     

CLINICAL IMPLICATIONS OF ELECTROPHYSIOLOGY STUDY FINDINGS IN PATIENTS WITH CHRONIC BIFASCICULAR BLOCK AND SYNCOPE

Electrophysiology study was performed in 93 patients with bifascicular block and unexplained syncope. Clinical evidence of organic heart disease was present in 33 (35%). Electrophysiological abnormalities were detected in 45 patients (48%). Of these, 36 had distal conduction disease, including 28 with an HV interval > 55 ms (mean 76.4 ms), and eight who developed infraHisian block following either intravenous procainamide (four) or atrial pacing (four). Sick sinus syndrome was evident in six patients and a further two had carotid sinus hypersensitivity. Sustained monomorphic ventricular tachycardia (VT) was induced in only three patients, two of whom also had prolonged HV interval. Among the 93 patients, 45 had therapy which was guided by positive findings at electrophysiology study (Group 1). Of these, 42 received permanent pacemakers, two were treated with combined permanent pacing and antiarrhythmic drug therapy, and one was treated with antiarrhythmic drug alone. In addition, eight patients without electrophysiologic abnormalities were treated empirically by pacing (Group 2). Finally, 40 patients without electrophysiologic abnormalities received no specific therapy (group 3). At a mean follow-up of 39 months (range two-125 months), recurrence of syncope had occurred in 4% of Group 1 patients, and 25% of Group 3 patients (p < 0.05). No patient in Group 2 had had recurrence. Total mortality was 40%, including 47% of patients in Group 1, 25% of Group 2, and 35% of Group 3. Death was sudden in seven patients. We concluded that among patients with bifascicular block and syncope, therapy directed by findings at electrophysiology study was associated with symptomatic improvement, but mortality was not significantly influenced. Patients with no electrophysiological abnormality have a high recurrence of syncope which may relate either to undetected bradyarrhythmia or ventricular tachycardia. These results highlight some limitations in current assessment, including, for programmed ventricular stimulation, significant differences in both stimulation protocols and the definition of ventricular tachycardia.     

Chinese herbs and warfarin potentiation by 'Danshen'

Drug interactions with warfarin can be dangerous and although common drug interactions are now well recognized those with Chinese herbs are not widely appreciated. 'Danshen' is a herbal medicine often used for various complaints, particularly cardiovascular, in the Chinese community. We report a case of danshen-induced overcoagulation with severe and dangerous abnormalities of clotting in a patient with rheumatic heart disease.     

Non-prescribed drug use during methadone treatment by clinic- and community-based patients

We investigated the efficacy of methadone maintenance treatment in clinic-based (n= 10) and community-based (n= 10) patients by studying the relationships between dose, plasma concentrations of methadone and non-prescribed drug-use using logistic regression. We found that clinic-based patients had significantly reduced odds of having a urine sample test positive for illicit drugs when compared to community-based patients (OR = 0.20; 95% confidence interval 0.10–0.38: p < 0.001). There was no relationship between either methadone dose or plasma methadone concentration and testing positive for non-prescribed drugs (including cocaine, cannabis, amphetamine, ecstasy, benzodiazepines). We looked specifically at the misuse of opiate drugs. Location was again important and clinic-based patients had significantly reduced odds of having a urine sample test positive for opiate drugs (OR= 0.36, 95% confidence internal 0.13–0.71: p～0.004). Opiate drug use in our patients was also significantly related to plasma methadone concentration, increasing noticeably when the drug concentration < 0.48 nmol/L (p～0.04). We found no relationship between methadone dose and odds of having a positive urine drug test in either clinic- or community-based patients.     

Technique and Results of Cardiac Transplantation Using "Domino-Donor" Hearts

Heart-lung transplantation is now well established for treatment of patients with terminal cardiopulmonary disease. More than 50% of heart-lung transplant recipients have normal or near normal hearts, with the majority having some degree of right ventricular hypertrophy. This potential source of "prepared" cardiac allografts remained untapped until the introduction of the "domino-donor" operation, a procedure in which the heart-lung recipient serves as a cardiac donor. The implantation of these available allografts contributes to the alleviation of the short supply of donor organs for cardiac transplantation. Aspects of the surgical technique, results, and potential benefits of this procedure are presented.     

The effects of platinum chemotherapy on essential trace elements

The effects of cisplatin chemotherapy on the metabolism of essential trace elements were investigated in 12 patients before and after treatment with cisplatin. In serum, the mean post-treatment concentrations of Cu (13.19 μmoll⁻¹), Zn (9.57 μmoll⁻¹) and Mg (0.54 mmoll⁻¹) were significantly reduced compared with the pre-treatment levels (19.35, 11.86 and 0.67) while Se, caeruloplasmin and C-reactive protein concentrations were unaltered. Urinary excretion of Cu, Mg and Zn were enhanced. The urinary N-acetyl-β-D-glucosaminidase activity (a marker of proximal renal tubular dysfunction) was also increased and suggests the mechanism for decrease of certain t race elements in serum during treatment could be increased urinary excretion caused by impaired cellular metabolism. It is not clear whether the loss of trace elements via the urine has any implication for the clinical status of cancer patients treated with cisplatin.