Search PubMed⌕ Search

Biomedical subjects

A Rogers

Publications and source records attributed to A Rogers.

At least 91 records · Page 5Linked to original sources
PubMed1998

Advice-giving in community pharmacy: variations between pharmacies in different locations.

The advice and services provided by community pharmacies are viewed by policy makers as having an increasingly important contribution to make as a primary health care resource to local populations. However, little attention has been given to the variations which may exist between pharmacies operating in different localities. Findings from an ethnographic study of pharmacies illuminate differences in the nature and quality of advice and services provided by pharmacies operating in disparate localities. Analysis of qualitative data suggests that differences in the environment within which pharmacies are located and organised influence the type of service provided to local populations. The possibility of an inverse care law operating in relation to the nature of services in poor urban localities compared to those in rural areas is also discussed.

Adult↗
PubMed1998

Social environment and substance misuse: a study of ethnic variations among inner London adolescents.

OBJECTIVES: To explore ethnic variations in drug, tobacco and alcohol use and their correlation with other factors which operate through peer, familial and religious influences. DESIGN: Semi-structured interviews with 132 12-13-year-old young people from four ethnic groups attending secondary schools in two inner London boroughs and a follow-up interview completed approximately 17 months later. RESULTS: The data was analysed using chi-square and McNemar tests. Familial, religious and peer influence closely correlated with ethnicity. Bangladeshi young people showed lower levels of peer and higher levels of religious and familial involvement and lower levels of substance use. White young people reported higher levels of peer, lower levels of religious and familial involvement, and a higher level of substance use. Black African and Black Caribbean young people lay between the two extremes. CONCLUSION: The findings suggest that young people with lower levels of familial and religious influence, or higher levels of peer influence, have higher levels of substance consumption than other young people. Health education initiatives need to promote personal decision-making skills within the context of the young people's individual culture. Cultural diversity should be recognised within local health education needs assessment.

Adolescent↗
PubMed1998

Explicit guidelines for qualitative research: a step in the right direction, a defence of the 'soft' option, or a form of sociological imperialism?

Within the context of health service research, qualitative research has sometimes been seen as a 'soft' approach, lacking scientific rigour. In order to promote the legitimacy of using qualitative methodology in this field, numerous social scientists have produced checklists, guidelines or manuals for researchers to follow when conducting and writing up qualitative work. However, those working in the health service should be aware that social scientists are not all in agreement about the way in which qualitative work should be conducted, and they should not be discouraged from conducting qualitative research simply because they do not possess certain technical skills or extensive training in sociology, anthropology or psychology. The proliferation of guidelines and checklists may be off-putting to people who want to undertake this sort of research, and they may also make it even more difficult for researchers to publish work in medical journals. Consequently, the very people who may be in a position to change medical practice may never read the results of important qualitative research.

Anthropology, Cultural↗
PubMed1998

Acclimation of photosynthesis to elevated CO2 under low-nitrogen nutrition is affected by the capacity for assimilate utilization. Perennial ryegrass under free-Air CO2 enrichment

Acclimation of photosynthesis to elevated CO2 has previously been shown to be more pronounced when N supply is poor. Is this a direct effect of N or an indirect effect of N by limiting the development of sinks for photoassimilate? This question was tested by growing a perennial ryegrass (Lolium perenne) in the field under elevated (60 Pa) and current (36 Pa) partial pressures of CO2 (pCO2) at low and high levels of N fertilization. Cutting of this herbage crop at 4- to 8-week intervals removed about 80% of the canopy, therefore decreasing the ratio of photosynthetic area to sinks for photoassimilate. Leaf photosynthesis, in vivo carboxylation capacity, carbohydrate, N, ribulose-1,5-bisphosphate carboxylase/oxygenase, sedoheptulose-1,7-bisphosphatase, and chloroplastic fructose-1, 6-bisphosphatase levels were determined for mature lamina during two consecutive summers. Just before the cut, when the canopy was relatively large, growth at elevated pCO2 and low N resulted in significant decreases in carboxylation capacity and the amount of ribulose-1,5-bisphosphate carboxylase/oxygenase protein. In high N there were no significant decreases in carboxylation capacity or proteins, but chloroplastic fructose-1,6-bisphosphatase protein levels increased significantly. Elevated pCO2 resulted in a marked and significant increase in leaf carbohydrate content at low N, but had no effect at high N. This acclimation at low N was absent after the harvest, when the canopy size was small. These results suggest that acclimation under low N is caused by limitation of sink development rather than being a direct effect of N supply on photosynthesis.

Journal Article↗
PubMed1998

Rationale and standards for the systematic review of qualitative literature in health services research.

Despite growing recognition of the need for qualitative methods in health services research, there have been few attempts to define quality standards for assessing the results. This article acknowledges the desirability of a plurality of standards. However, it is argued that three interrelated criteria can be identified as the foundation of good qualitative health research: interpretation of subjective meaning, description of social context, and attention to lay knowledge. These criteria can be examined in relation to different dimensions of any research report, including theoretical basis, sampling strategy, scope of data collection, description of data collected, and concern with generalizability or typicality. But if the concern is with the appropriateness of care and with understanding the factors that shape lay and clinical behavior, then these criteria must form the basis of a hierarchy of qualitative research evidence.

Humans↗
PubMed1998

Advice provided in British community pharmacies: what people want and what they get.

OBJECTIVES: This study explored advice-giving behaviour in community pharmacies in order to understand the nature and process of pharmaceutical consultations and consumers' views of the advice-giving role. METHOD: An ethnographic research strategy was used, combining patient interviews with non-participant observation of interactions between consumers and pharmacy staff. One week was spent in each of 10 pharmacies. RESULTS: The study demonstrated that the advice given in a community pharmacy is almost wholly focused on product recommendation and use. Advice-giving varies according to whether consultations concern prescription or non-prescription medicines. When the latter are involved, advice-giving is mostly consumer-led. Consumers' major 'need' for pharmacy services appears to be for information about the effectiveness of products they buy, whilst pharmacists and pharmacy assistants concentrate on providing advice on the safety of medicines. CONCLUSION: The notion of pharmacists as general health advisors does not appear to be shared by the public and may be at odds with how the public view and use pharmacies. Protocols to guide staff may be improved by including the consumer perspective. Most consumers have previous experience of their ailments and use pharmacies as one of several resources available to them to treat their minor illness, having made their own diagnosis and assessment before entering the pharmacy. The scope for giving new advice is therefore limited. The broader role of community pharmacies merits further attention.

Counseling↗
PubMed1998

Effects of estrogen therapy of postmenopausal women on cytokines measured in peripheral blood.

Estrogen replacement therapy (ERT) is known to prevent bone loss following the menopause, but the mechanism for this is unclear. Estrogen may suppress the secretion of certain bone-resorbing cytokines. The aim of this study was to assess the effect of ERT on the levels of cytokines measured in peripheral blood. We measured cytokines in 10 postmenopausal women (ages 56-59, 3-9 years since menopause) treated with ERT and 10 age-matched (54-59 years, 4-10 years since menopause) untreated women as controls. Samples of blood were taken and used for mononuclear cell cultures, whole blood (WB) cultures, and the separation of serum. The cultures were treated with lipopolysaccharide (LPS; 500 ng/ml) and hydrocortisone (10(-6) M). The conditioned medium from cultures and the serum were then assayed for interleukin-6 (IL-6), IL-1alpha IL-1beta, IL-1 IL-1ra, tumor necrosis factor alpha (TNF-alpha), and granulocyte macrophage colony stimulating factor (GM-CSF) by enzyme-linked immunosorbent assay. M-CSF and the soluble cytokine receptors soluble IL-6 receptor (sIL-6r) and soluble TNF receptor type 1 (sTNFr1) were also measured in serum and M-CSF in stimulated WB cultures. Measurements were corrected for mononuclear cell count. We also measured serum bone-specific alkaline phosphatase (ibAP) in all subjects. We found that LPS stimulated secretion of all cytokines both in WB and isolated cell cultures, and that this was attenuated by hydrocortisone. A significantly higher ratio of IL-1beta/IL-1ra (p = 0.02) in LPS stimulated WB cultures was seen in the untreated women. Levels of IL-1beta and IL-1alpha measured in WB cultures were lower and IL-1ra was higher in the ERT-treated group but these results were not significant. BAP was higher in the untreated group (p = 0.005) and correlated with IL-alpha/IL-1ra in the whole group (r = 0.49, p = 0.03). Results of other measurements showed no significant differences between groups. We conclude that estrogen may prevent bone loss following the menopause by altering the balance between IL-1beta and IL-1ra.

Administration, Cutaneous↗
PubMed1997

Recurrent Crohn's disease in transplanted bowel.

BACKGROUND: Intestinal transplantation is used in patients with short-bowel syndrome after repeated resections for Crohn's disease. We report the apparent clinical recurrence of Crohn's disease in a transplanted intestine. METHODS AND FINDINGS: The patient, a 33-year-old Hispanic woman, underwent small-bowel transplantation in December, 1994. Immunosuppression with tacrolimus, methylprednisolone, bone-marrow infusions, and OKT3 was given. In July, 1995, the patient had recurrent abdominal symptoms. The histological diagnosis of Crohn's disease was established by the independent interpretations of four experienced gastrointestinal histopathologists. INTERPRETATION: The prompt appearance of this autoimmune disorder (within 6 months of transplantation), despite massive immunosuppression may provide important insights into the nature of Crohn's disease and of the recurrence of autoimmune disease during immunosuppression.

Adult↗
PubMed1997

Variations in health behaviours among inner city 12-year-olds from four ethnic groups.

OBJECTIVES: To describe factors that contribute to variations in health-related behaviours and attitudes among inner city 12-year-olds. To see if there was an identifiable patterning by ethnic group. DESIGN: Semi-structured interviews with a stratified sample of 12-year-old students and their parents from four ethnic groups, attending state secondary schools in two inner London boroughs. RESULTS: Bangladeshi young people were significantly more likely to receive school meals. There was no variation in reported snacking between the groups. Girls and Bangladeshi students were less likely to report exercising outside school (33% of Bangladeshi boys reported not exercising outside school compared to 5% of boys from all other groups). Bangladeshi boys and their parents were more likely to report that bullying or worries about racial violence prevented them from going out after school. White young people were more likely to report experimenting with and the regular use of cigarettes and alcohol. Use of alcohol and cigarettes was also associated with gender, religion and strength of religious observance. White parents were the least likely to report restricting their child's social activities as a way of influencing behaviour and expressed more concerns about their child's potential for health-damaging behaviour than parents in all other groups. CONCLUSION: This study shows that ethnicity alone is insufficient and inadequate in explaining variations in health behaviours among inner city teenagers. A complex mix of personal, cultural and social factors including ethnicity shape the behaviours and attitudes of these young people.

Black or African American↗
PubMed1997

A pathway to the GP: the pharmaceutical 'consultation' as a first port of call in primary health care.

OBJECTIVE: This study explored advice-giving behaviour of staff in community pharmacies in order to generate fresh insights into the nature, sequence and process of pharmacy consultations for minor ailment advice. METHOD: An ethnographic-style research strategy was used, combining staff and patient interviews, with non-participant observation of medicines and health-related interactions between pharmacy users and staff. One full week was spent in each of ten pharmacies. RESULTS: The study highlighted that patients use pharmacies for treatment of minor ailments, sometimes before going to the GP, and sometimes in preference to the GP. By matching remedies to conditions, community pharmacy staff play a major role in keeping minor ailments out of general practice, but act as an agent of referral in cases which merit a GP consultation. CONCLUSION: It is in the interests of GPs to 'exploit' the advisory role of the pharmacist. A two-way referral system would allow doctors to build on the professional skills of the pharmacist as an over-the-counter expert, while ensuring that pharmacists have a channel through which to filter patients with potentially serious illnesses.

Adolescent↗
PubMed1996

Malignancy in Crohn's disease.

The risk for the development of malignancy in Crohn's disease is not as well defined as it is with ulcerative colitis. The risk for the development of small bowel adenocarcinoma is greater in patients with Crohn's disease than in the general population although the magnitude of this increased risk is unclear. Risk factors associated with the development of small bowel carcinoma in Crohn's disease include male sex, duration of disease, associated fistulous disease, and the presence of surgically excluded loops of bowel. Crohn's colitis has been associated with an increased risk of colorectal carcinoma in patients with long-standing colitis, strictures, fistulae, and right-sided colonic disease. Secondary gastrointestinal carcinomas are rare in Crohn's disease. This article reviews the current literature regarding the association of various malignancies in Crohn's disease. Although concentrating on population based and case-control studies, it includes referral center studies as well as case reports.

Case-Control Studies↗