Philip Sedgwick

Incidence and demographic correlates of depressive symptoms during pregnancy in an inner London population

This paper reviews the literature on antenatal depression and reports on a recent survey of depressive symptoms among 407 women attending an inner London antenatal clinic. The high level of depressive symptoms in this survey was in line with that recently reported from a deprived inner-city population in the United States. Depressive symptoms were associated with having no educational qualifications, being unmarried, the woman being unemployed, having poor support from a partner if present, and being in second or subsequent pregnancy. Doctors should be aware that women are not especially protected from symptoms of depression during pregnancy. The association with socioeconomic problems suggests that this is one aspect of morbidity among disadvantaged people. There is a need for more research on the causes of depression during pregnancy and on evaluation of medical treatment and social intervention.

Subjective sleep-wake parameters in treatment-seeking opiate addicts.

We investigated subjective sleep parameters and sleep difficulties of opiate addicts undertaking methadone detoxification and identified their sleep profile. Using the St Marys Sleep Questionnaire, we compared the subjective sleep parameters of 27 consecutively consenting patients (16 males, 11 females) with a mean age of 33 years (S.D. = 7.5) undertaking in-patient methadone detoxification with those of 26 drug-free controls (9 males, 17 females) with a mean age of 35 years (S.D. = 8.0). Our findings reveal that subjective sleep parameters of opiate addicts and controls are quantitatively and qualitatively different. The patients are more likely than controls to report difficulty initiating sleep (OR = 5.42; 95% CI = 1.43, 20.47); difficulty maintaining sleep (OR = 16.50; 95% CI = 3.81, 71.47); inadequate sleep quality (OR = 8.56; 95% CI = 2.04, 35.81); and inadequate sleep quantity (OR = 9.00; 95% CI = 2.49, 32.57).

Drug use, self report and urinalysis

Stimulated by the ever present demand to consider the financial implications in management decisions, this study examines the use of urinalysis and self-report in the treatment of drug users, to question if urinalysis, rather than being a routine investigation, could be used with greater discrimination without jeopardising its effectiveness. It concludes that urinalysis remains of importance, as an adjunct to self-report, in providing information and in the treatment of drug users. Suggestions are made as to how it might be used more selectively in treatment based on a clinical knowledge of individual patients and their progress in treatment. However further research is needed to support and define this more clearly.

Incidence and demographic correlates of eating disorder symptoms in a pregnant population.

OBJECTIVE To obtain a picture of eating disorder symptoms in a population of pregnant women. METHOD Five hundred thirty women attending antenatal follow-up clinics at a large London district general hospital during a 4-week period were surveyed. The Eating Attitudes Test (EAT), the Edinburgh Postnatal Depression Scale (EPDS), and a demographic questionnaire were administered. Unadjusted relative risks and their 95% confidence intervals were calculated for a series of prognostic factors. RESULTS 4.9% of women scored above the recommended threshold on the EAT in pregnancy. Eating disorder symptomatology was found to be associated with younger age, previous symptomatology, lower educational attainment, poorer housing, employment status, and previous miscarriage. DISCUSSION The meaning and potential implications of high levels of eating disorder symptomatology in a pregnant population are discussed in the light of the physiological and psychological effects of eating disorders on both pregnancy outcome and infant development.

Management of acute renal colic in the UK: a questionnaire survey

BackgroundThere is great variation in the Accident and Emergency workload and location of Urology services in UK hospitals. This study investigated the relationship of the initial management of acute renal colic with the department workload plus local facilities including location of X-ray and urology services in UK Accident and Emergency (A&E) departments.MethodsA&E departments in each of the 11 UK Deanery regions were stratified based on departmental workload, namely <30,000 (small); 30,000 to 50,000 (medium); 50,000 to 80,000 (large) and >80,000 (very large) patients per year. One third of departments were selected in each group leading to a sample size of 106. A questionnaire was administered. Associations between categorical variables were investigated using the chi-squared test and when not valid, Fishers Exact test was employed. Differences between groups in ordinal variables were investigated using the Mann-Whitney test.ResultsAll questionnaires were returned. Twenty-nine units (27.4%) did not perform any radiological investigation on renal colic patients. The number of radiological investigations that were available to departments was associated with workload (P = 0.003); with 57.1% of the small departments performing none and at least 82.8% of units in the other categories performing at least one. Of those departments with X-ray facilities in or adjacent to the department, 63% performed an intravenous urography (IVU) compared to 25% of those departments without (P = 0.026). Of those departments with on-site urology services, 86% performed at least one radiological investigation compared to 52% of units without such services (P = 0.001). Department workload was associated with the first choice analgesia (NSAIDs or parenteral opiates) (P = 0.011). Of the small departments, 64.3% used NSAIDs, 21.4% used parenteral opiates and 14.3% used neither. In comparison, NSAIDS were used by at least 87%, and opiates by at most 12.5% of units in each of the other three categories of department workload.ConclusionsOver a quarter of UK A&E departments did not perform any radiological investigations and some departments do not even offer renal colic patients any analgesia. Patient management was associated with departmental workload, location of X-ray and Urology services. National guidelines are needed to ensure optimum care for all patients.

Do Blood Pressure Levels and Other Patient Characteristics Influence Native Fistula Patency

Arteriovenous fistulas (AVFs) play an important role in access for hemodialysis, yet premature thrombosis is a challenge. This study identifies factors influencing primary patency in a series of AVF creations. Postoperative systolic blood pressure (BP) was of principal interest; demographical information, comorbidities, smoking status, warfarin, aspirin, clopidogrel, and statins were considered.

Changing pattern of drug use in individuals with severe drug dependence following inpatient treatment

Ninety-seven subjects (92 of whom were opiate users) admitted to an inpatient treatment unit were followed 3, 6, 9, and 12 months after discharge using the Substance Abuse Assessment Questionnaire (SAAQ).(1) The subjects presented problems of severe drug use, frequently complicated by additional difficulties; 67% of the sample completed detoxification. Significant reductions in daily drug use were seen at 12 months for each major class of drug, except cannabis. One-third of daily opiate users had been abstinent from opiates for at least one month prior to the final follow-up. Most changes took place between admission and the 3-month follow-up, and these improvements were maintained across the sample as a whole. Within the sample, fluctuations in drug use were observed, with subjects both relapsing to, and remitting from, drug use. Subjects who achieved at least one 3-month period of abstinence were more likely to have been employed at admission, and also more likely to have committed an offence immediately prior to admission, than those who did not achieve this level of abstinence. These results suggest that detoxification programmes produce benefits which can be maintained in the medium term. Further longitudinal studies are required to investigate the triggers for both relapse and remission.

Can the factors influencing medication compliance reported from Western populations be applied to an eastern Indian context? Part I

Non-compliance to psychotropic medication is a major concern globally. Most research has been carried out in Western countries and may have limited applicability in developing countries where psychotropic medication is the mainstay of treatment. The aim of this study was to investigate if those factors identified as influencing compliance in Western populations can be applied to an eastern Indian context. During a three-month period at a tertiary referral centre in eastern India a sample of 90 clients was achieved. In Western populations four main groups of variables have been identified as important in determining compliance to psychotropic medication, namely socio-demographic, socio-cultural, illness and treatment factors. However, most of these variables were found to have limited significance in this study. Decisions about medication compliance were made by both the client and significant others within their family. Transcultural differences and therapeutic implications of the study in a Western context are discussed.