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Biomedical subjects

A Haines

Publications and source records attributed to A Haines.

At least 91 records · Page 5Linked to original sources
PubMed1994

Evaluation of the use of brief screening instruments for dementia, depression and problem drinking among elderly people in general practice.

BACKGROUND: Use of brief screening instruments for detection of psychological morbidity among elderly people is being promoted, although the appropriateness and effectiveness of available instruments have not been evaluated in general practice. AIM: This study set out to determine the outcome of opportunistic use of brief screening instruments for dementia, depression and problem drinking in randomized trials in two group practices in north west London. METHOD: Screening instruments were inserted into a random sample of medical records for people aged 75 years and over in each practice. Medical records of those seen by their general practitioners over a six month period were reviewed for new diagnoses of dementia (or confusion), depression or problem drinking, and the scores obtained on screening instruments noted. The records of all those identified as possibly demented, depressed or drinking heavily were reviewed one year after screening and all relevant referrals and new treatments were noted. RESULTS: In one practice use of screening instruments resulted in a significant increase in the detection of possible dementia, but not of depression. In the second practice screening instruments yielded significantly higher numbers with possible dementia or depression. Heavy drinking was uncommon in either population. There was no difference in the proportions of cases identified by screening instrument or by clinical judgement alone who received treatment or referral. CONCLUSION: These results suggest that in the absence of agreed guidelines and resources, information derived from screening instruments may not alter clinical practice.

Aged↗
PubMed1993

Accuracy of diagnosis of psychosis on general practice computer system.

OBJECTIVES: To determine the accuracy of diagnoses of schizophrenia and non-affective psychosis entered by general practitioners on a computer system. To compare recording of clinical events on computer with written records. DESIGN: Examination of case notes of all patients with a computer diagnosis of psychosis. Search of 8000 randomly selected patient records to identify patients with psychosis not recorded on computer and comparison of 141 computer and written entries for prescribing and consultation in each practice. SETTING: 13 London practices on the VAMP research bank. MAIN OUTCOME MEASURES: Accuracy of record of psychosis compared with ICD 9, American Psychiatric Association diagnostic manual, and syndrome checklist criteria. RESULTS: Computer search revealed 102 patients with schizophrenia, 78 with other psychoses, and 71 with non-affective psychosis who had adequate case notes. The sensitivity and positive predictive value of the computer diagnosis of schizophrenia were 88% (95% confidence interval 62% to 98%) and 71% (48% to 88%). For all non-organic psychoses sensitivity was 91% (74% to 97%) and positive predictive value was 91% (74% to 98%). On average 95% of all known prescriptions and 74% of all consultations were recorded on computer compared with 42% and 75% in written records. CONCLUSIONS: Recording of psychotic illness on the VAMP computer is accurate and complete. Prescribing was more fully recorded on the computer than on the written records. Computer databases of well motivated general practitioners could be used for research.

Ambulatory Care Information Systems↗
PubMed1993

Medical education.

Explore the source record for details and available documents.

Education, Medical, Undergraduate↗
PubMed1993

Health care in Brazil.

Brazil has great geopolitical importance because of its size, environmental resources, and potential economic power. The organisation of its health care system reflects the schisms within Brazilian society. High technology private care is available to the rich and inadequate public care to the poor. Limited financial resources have been overconcentrated on health care in the hospital sector and health professionals are generally inappropriately trained to meet the needs of the community. However, recent changes in the organisation of health care are taking power away from federal government to state and local authorities. This should help the process of reform, but many vested interests remain to be overcome. A link programme between Britain and Brazil focusing on primary care has resulted in exchange of ideas and staff between the two countries. If primary care in Brazil can be improved it could help to narrow the health divide between rich and poor.

Brazil↗
PubMed1993

Screen detected high blood pressure under 40: a general practice population followed up for 21 years.

OBJECTIVE: To assess hypertension detected under 40 in a general practice population. DESIGN: Prospective case-control study. SETTING AND SUBJECTS: Former coal mining community in south Wales. Systematic case finding for hypertension and associated risk factors applied to a mean total population of 1945 from age 20 on a five year cycle through 21 years. Mean population aged 20-39, 227 men and 213 women. Case criteria: age < 40 and mean systolic pressure > or = 160 mm Hg or diastolic pressure > or = 100 mm Hg. Age and sex matched controls randomly sampled from the same population. MAIN OUTCOME MEASURES: Mean initial pressures and pressures at follow up in 1989 or preceding death, and all cardiovascular events. RESULTS: 25 men and 16 women met criteria. Estimated five yearly inceptions were 26/1000 for men and 18/1000 for women. Male group mean initial blood pressure was 164/110 mm Hg for cases, falling to 148/89 mm Hg at follow up. Five male cases died at mean age 47.8, compared with two controls at 49.5. Female group mean initial pressure was 172/107 mm Hg for cases, falling to 145/86 mm Hg at follow up. One female case died aged 50, no controls. 10 male cases had non-fatal cardiovascular events at mean age 40.2, compared with two controls at mean age 50.5. Four female cases had non-fatal events at mean age 47.2, compared with one control aged 58. Male differences were statistically significant. CONCLUSIONS: Hypertension under 40 is dangerous, commoner in men than women, rarely secondary to classic causes, and may be controlled in general practice on a whole community basis.

Adult↗
PubMed1993

The involvement of general practitioners in the care of patients with human immunodeficiency virus infection: current practice and future implications.

The objective was to determine the current use of their general practitioner (GP) by patients with human immunodeficiency virus (HIV) infection and whether such patients would be interested in having 'shared care' between a specialist HIV clinic and their GP. A questionnaire was administered to 203 HIV-positive men attending the HIV outpatient clinic of a central London teaching hospital. The main outcome measures were patient characteristics, numbers of patients registered with a GP, numbers of patients with a GP aware of their diagnosis, contacts with the GP in the last year and level of interest and shared care. Eighty-five per cent of patients were registered with a GP of whom 67% knew of the diagnosis. Those diagnosed for more than 2 years were significantly more likely to have an informed GP. A total of 73% of those registered had visited their GP in the previous year although only 27% had visited for an HIV-related problem. Only 19% had a GP actively involved in their HIV care. In all 51% of the patients indicated an interest in having shared care between the clinic and their GP. A high proportion of HIV patients are registered with and attend a GP although they rarely consult for HIV-related problems. A significant proportion of patients expressed interest in having shared care suggesting that there is the potential for increased GP involvement in the care of patients with HIV infection.

Adolescent↗
PubMed1993

Assessment of elderly people in general practice. 4. Depression, functional ability and contact with services.

The aim of this study was to look at the interrelationship between depression, physical disability and contact with services. In a random sample of 239 people aged 75 years and over from nine general practices in north London, depression (as measured by a shortened version of the comprehensive assessment and referral evaluation schedule) was found to be significantly associated with being a woman, and inability to perform a number of activities of daily living. Consumption of three or more prescribed medicines, a home visit by the general practitioner in the previous three months and contact with health visitors and home helps were all significantly more likely among depressed patients. There were also significant associations between loss of functional abilities, measured using items from an activities of daily living scale, and use of certain services: general practitioner home visits and reduced mobility indoors and both home help and district nurse visits to those with difficulty in bathing. Multiple logistic regression analysis suggested that contact with services was principally associated with loss of mobility, although contact with home helps was independently associated with depression, when adjustment was made for functional impairment.

Aged↗
PubMed1992

Are elderly people living alone an at risk group?

OBJECTIVE: To test the hypothesis that elderly people living alone are an at risk group with a high level of morbidity that makes high demands on health and social services. DESIGN: Secondary analysis of data from a community survey of 239 people aged 75 and over, identified from general practitioners' age-sex registers. SETTING: Nine practices in the London boroughs of Brent and Islington. MAIN OUTCOME MEASURES: Scores on the mini-mental state examination; stated satisfaction with life; assessment of mobility; numbers of diagnoses of major physical problems; numbers of prescribed drugs taken; urinary incontinence; alcohol consumption; contacts with general practitioners and hospital outpatient and inpatient services; contact with community health and social services. RESULTS: There were significantly more women among those living alone (93/120 (78%) v 63/119 (53%); p < 0.0005) and the median age of elderly people living alone was higher (81 v 80; p < 0.04). Those living alone and those living with others showed no significant differences in measures of cognitive impairment, numbers of major physical diagnoses, impaired mobility, or use of general practitioner or hospital services. Stated satisfaction with life was somewhat higher in those living alone. Elderly people living alone were significantly more likely to have contact with chiropody, home help, and meals on wheels services and less likely to have someone they could contact in an emergency or at night. Living alone increased the likelihood of contact with one or more community health professionals (district nurses, health visitors, or chiropodists) considered as a group and also increased the likelihood of contact with social services as a whole. There was a tendency for more of those living alone than those living with others to have home visits from their general practitioners, but there were no significant differences in contact with hospital services between the two groups. CONCLUSIONS: Elderly people living alone do not have an excess of morbidity compared with those living with others and do not seem to be an at risk group requiring specifically targeted assessments. More help is needed to provide elderly people living alone with a point of contact in case of emergency.

Aged↗
PubMed1991

Adolescent smokers seen in general practice: health, lifestyle, physical measurements, and response to antismoking advice.

OBJECTIVE: To compare physical, lifestyle, and health characteristics of adolescent smokers and non-smokers and their initial response to anti-smoking counselling. DESIGN: Adolescents aged 13, 15, and 17 years were identified from age-sex registers and invited by letter for a general practice health check. SETTING: Three general practices in the MRC general practice research framework. MAIN OUTCOME MEASURES: Blood pressure, body mass index, saliva cotinine concentration, peak flow rate, alcohol consumption, exercise, duration of sleep, and stated persistent health problems. RESULTS: 73% of the adolescents (491) attended for the health check. A total of 68 (14%) were regular smokers. By age 17 those who smoked regularly had a significantly lower systolic blood pressure than those who had never smoked regularly (by 6 mm Hg; p = 0.025) despite a significantly higher body mass index (by 1.5; p <0.001) [corrected]. Cotinine concentrations increased with smoking exposure, from 0.7 ng/ml when no family member smoked to 155 ng/ml in active smokers of six or more cigarettes a week. Significantly more regular smokers than never regular smokers drank greater than or equal to 8 g alcohol a day (chi 2 = 15.2 adjusted for age and sex p less than 0.001); regular smokers exercised less (1.0 hrs/week in boys and 0.8 hrs/week in girls v 3.4 hrs/week in boys and 2.2 hrs/week in girls; p less than 0.001) and slept less (8.0 hrs/night v 8.5 hrs/night at age 17; p less than 0.005). Persistent health problems, mostly asthma or allergic symptoms, were reported by 25% (17/68) of the smokers and 16% (60/381) of the non-smokers. Of the smokers given counselling, 60% (26/43) made an agreement with the practice doctor or nurse to give up smoking. CONCLUSION: General practice is an appropriate setting for adolescents to receive advice on healthy lifestyle, which should not focus solely on smoking.

Adolescent↗