Biomedical subjects

A Killoran

Publications and source records attributed to A Killoran.

13 recordsLinked to original sources

PubMed2006

What sort of networks are public health networks?

BACKGROUND: Re-organization of the English National Health Service (NHS) has fragmented the public health workforce, relocating teams from about 100 health authorities into over 300 primary care trusts (PCTs). The UK Government announced the setting up of public health networks (PHNs) as a solution to the problems created by fragmentation. METHODS: Fifty-seven semi-structured telephone interviews were held with key players in PHNs in all strategic health authority areas in England in early 2003. RESULTS: PHNs appeared to be primarily networks of public health professionals rather than of organizations. Informants were unsure about PCTs' commitment to public health. Predominantly, members were those NHS personnel with a clear and explicit public health role. Most PHNs intended to include others later (e.g. health visitors, environmental health officers), although a few thought that inclusivity was essential from the start. Continuing professional development for public health personnel dominated the work being undertaken, with some collaborative work across PCTs. PHNs were seen as a compulsory reconfiguration of existing networks, and informants doubted that they were appropriate for the many levels of networking that public health work requires. CONCLUSION: The formation of PHNs does not appear to have been either necessary or sufficient. However, the public health community has a well-established tradition of networking, and therefore has the skills to use PHNs advantageously.

Community Networks↗

PubMed2003

Characterization of SrgA, a Salmonella enterica serovar Typhimurium virulence plasmid-encoded paralogue of the disulfide oxidoreductase DsbA, essential for biogenesis of plasmid-encoded fimbriae.

Disulfide oxidoreductases are viewed as foldases that help to maintain proteins on productive folding pathways by enhancing the rate of protein folding through the catalytic incorporation of disulfide bonds. SrgA, encoded on the virulence plasmid pStSR100 of Salmonella enterica serovar Typhimurium and located downstream of the plasmid-borne fimbrial operon, is a disulfide oxidoreductase. Sequence analysis indicates that SrgA is similar to DsbA from, for example, Escherichia coli, but not as highly conserved as most of the chromosomally encoded disulfide oxidoreductases from members of the family Enterobacteriaceae. SrgA is localized to the periplasm, and its disulfide oxidoreductase activity is dependent upon the presence of functional DsbB, the protein that is also responsible for reoxidation of the major disulfide oxidoreductase, DsbA. A quantitative analysis of the disulfide oxidoreductase activity of SrgA showed that SrgA was less efficient than DsbA at introducing disulfide bonds into the substrate alkaline phosphatase, suggesting that SrgA is more substrate specific than DsbA. It was also demonstrated that the disulfide oxidoreductase activity of SrgA is necessary for the production of plasmid-encoded fimbriae. The major structural subunit of the plasmid-encoded fimbriae, PefA, contains a disulfide bond that must be oxidized in order for PefA stability to be maintained and for plasmid-encoded fimbriae to be assembled. SrgA efficiently oxidizes the disulfide bond of PefA, while the S. enterica serovar Typhimurium chromosomally encoded disulfide oxidoreductase DsbA does not. pefA and srgA were also specifically expressed at pH 5.1 but not at pH 7.0, suggesting that the regulatory mechanisms involved in pef gene expression are also involved in srgA expression. SrgA therefore appears to be a substrate-specific disulfide oxidoreductase, thus explaining the requirement for an additional catalyst of disulfide bond formation in addition to DsbA of S. enterica serovar Typhimurium.

Amino Acid Sequence↗

PubMed1998

Primary care groups. Growing pains.

The management costs of primary care groups are likely to be higher than envisaged. Duplication of all functions in all PCGs is likely to be more expensive than current health authority commissioning arrangements. In the long term, the most effective deployment of management costs will depend on deciding which PCG commissions what.

Budgets↗

PubMed1997

Physical activity promotion through primary health care in England.

BACKGROUND: There is increasing research supporting the argument for a beneficial link between physical activity and health maintenance and, in the past five years, this has led to a growth in physical activity promotion schemes involving primary health care. AIM: To document and critically examine the extent and nature of physical activity promotion in general practice in England. METHOD: A postal survey to all family health services authorities and primary care facilitators was conducted to identify existing and planned activity promotion schemes involving primary health care. Telephone interviews with leaders from 50 selected schemes and further detailed case studies of 11 schemes provided descriptive information of the nature of physical activity promotion. RESULTS: The initial phase revealed 157 existing schemes and a further 35 planned schemes. Two basic models of physical activity promotion were identified that were distinguishable by the primary location of the management of the patient. Practice-managed interventions (32%) involve on-site counselling to change the behaviour of patients. Leisure centre-managed projects (68%), sometimes termed 'exercise by prescription' or 'general practitioner referral for exercise' schemes, involve the identification of suitable patients and their referral to 10- to 12-week-long leisure centre based exercise induction courses. The projects in the planning stage were all of the latter type, indicating this as the favoured model. Although such schemes were generally successful in attracting patients, in all cases they involved less than 1% of the patient base from which they were drawn. CONCLUSION: There is evidence of successful recruitment, increased short-term physical activity and fitness, and improvements in the well-being of patients. However, schemes are inadequately resourced for rigorous long-term evaluation; therefore, conclusions regarding the cost-effectiveness of the two models are not possible.

England↗

PubMed1996

Reducing the burden of coronary heart disease: health promotion, its effectiveness and cost.

Coronary heart disease (CHD) is one of five key areas identified in the Health of the Nation white paper produced by the Department of Health in 1992. The main CHD targets are to reduce death rates from CHD by at least 40% in people below 65 and 30% in those between 65 and 74 by the year 2000, respectively. Improvements in treatment and rehabilitation are expected to contribute to reducing the burden of CHD; however, in the long term, prevention is believed to hold the greatest potential. CHD health promotion therefore has a big role to play in securing the Health of the Nation targets. In contrast to treatment interventions, however, little is known about the effectiveness or cost-effectiveness of health promotion. The purpose of this article is two-fold. Its main aim is to illustrate the potential of health promotion in reducing the health burden of CHD to the turn of the century and beyond for a representative health purchaser. This is achieved with the use of an epidemiological model, Prevent, developed in the Netherlands to simulate the health outcomes associated with health promotion and prevention. A subsidiary aim is to present tentative information about the relative costs associated with different health promotion options.

Adult↗

PubMed1994

Involvement of the primary health care team in coronary heart disease prevention.

BACKGROUND: Recent years have seen a vast increase in the amount of health promotion activity undertaken in general practice. AIM: This study set out to identify the level of general practitioner and nurse involvement in activities aimed at coronary heart disease prevention and to examine variations in involvement. METHOD: A questionnaire survey was undertaken of a sample of general practitioners across England and the nurses who worked in their practices. RESULTS: Of 1696 randomly selected general practitioners 64% completed a questionnaire, of 928 practice nurses 71% responded and of 682 health visitors and 679 district nurses 52% and 40% responded, respectively. Of the general practitioners 94% reported that they were involved in assessing lifestyle risk factors in the routine consultation and regular assessments most commonly involved blood pressure testing and inquiry about smoking status. Eighty six per cent of practices were reported by the practice nurse as having well person clinics; these clinics were usually run by the practice nurse. Clinics for the management of specific lifestyle risk factors were also usually run by practice nurses, although many doctors were involved in hypertension clinics and cholesterol clinics. Health visitors and district nurses had a low level of involvement in this practice based clinic activity. Involvement of general practitioners and practice nurses in coronary heart disease prevention was associated with training in health promotion and positive attitudes towards prevention and health promotion. The level of involvement of practice nurses in health promotion was associated with the support received from primary health care facilitators, family health services authorities and district health authorities. CONCLUSION: Members of the primary health care team appeared to have their own distinct area of preventive activity. However, this division did not appear to be a result of organized teamwork and deployment of skills and expertise according to a clearly defined management protocol. Instead it seemed to be a product of general practitioner contract and management arrangements which tended to encourage an approach to general practice health promotion which revolved around the practice nurse and which hindered the development of a broader team based approach to planning and delivery of health promotion in relation to the needs of the practice population.

Coronary Disease↗

PubMed1993

Last gasp.

Next Monday's World No-Tobacco Day is also the last day on which smoking will be allowed in UK hospitals. Amanda Killoran and colleagues urge local health authorities to seize the initiative.

Humans↗

PubMed1993