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Biomedical subjects

B Sibbald

Publications and source records attributed to B Sibbald.

At least 199 records · Page 11Linked to original sources
PubMed1991

HIV/AIDS workshop for primary health care staff.

The purpose of this study was to develop and pilot a workshop to train general practitioners and other primary care workers to become competent in the primary, secondary and tertiary prevention of acquired immunodeficiency syndrome (AIDS). The development of the workshop took place at four venues in the South West Thames Region and involved 41 general practitioners and 33 primary care nurses. Questionnaire evaluation before and immediately after each workshop showed a significant improvement in participants' attitudes towards the prevention and management of human immunodeficiency virus (HIV) infection in general practice. We conclude that a suitably designed workshop can be effective in improving the attitudes of primary health care workers towards AIDS prevention and care.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Epidemiology of seasonal and perennial rhinitis: clinical presentation and medical history.

BACKGROUND: Little is known about the epidemiology of rhinitis, particularly the perennial and non-allergic forms. The aim of this study was to compare the symptoms, atopic state, and medical history of individuals with seasonal and perennial rhinitis. DESIGN: Of 7702 adults aged 16-65 years registered with a London general practice, 2969 (30%) were screened by postal questionnaire. Samples of 113 subjects without rhinitis, 51 with seasonal symptoms alone, 128 with perennial symptoms and seasonal exacerbations were then interviewed. Atopic and non-atopic subjects were distinguished by skinprick testing with five common allergens. RESULTS: The estimated minimum prevalence of rhinitis was 24%: 3% had seasonal symptoms only, of whom 78% were atopic; 13% had perennial symptoms only, of whom 50% were atopic; and 8% had perennial symptoms with seasonal exacerbations, of whom 68% were atopic. Seasonal rhinitis was characterised by sneezing, itching, and a high prevalence of diurnal variation in symptoms. The most common provoking factors were dust, pollens, and infections. By comparison, perennial rhinitis was characterised by a higher prevalence of nasal blockage and catarrh, and a lower prevalence of diurnal variation and provocation by pollen. There were no significant differences among the groups in the sociodemographic characteristics examined. Subjects with seasonal rhinitis were more likely to be atopic and to have eczema and a family history of hayfever than those without rhinitis. Those with perennial rhinitis were more likely to have past or current eczema or migraine, be wheezy or labelled asthmatic, or have a family history of nose trouble other than hayfever. Subjects with both seasonal and perennial symptoms presented an intermediate clinical picture. CONCLUSIONS: Seasonal and perennial rhinitis differ in their atopic state, clinical presentation, and medical history. The extent to which these differences are genetically or environmentally determined requires further investigation.

Adult↗
PubMed1991

Labelling of rhinitis and hayfever by doctors.

Factors influencing the labelling of rhinitis by doctors were examined in 7702 adults, aged 16-65 years, registered with a group general practice in south London. Individuals with rhinitis were identified by a postal screening questionnaire. Of the 2969 (39%) subjects who replied, 1309 (44%) reported rhinitis. A sample of 340 individuals with and 126 without rhinitis was studied, each being interviewed and having allergy skinprick tests. The information given at interview was compared with that recorded in the medical notes for 75 patients with rhinitis, selected at random to include 25 with seasonal symptoms only, 25 with perennial symptoms only, and 25 with both seasonal and perennial symptoms, plus 25 control subjects. Hayfever was defined as seasonal symptoms provoked by grass and a positive skin test response to grass pollen. Subjects with seasonal symptoms were nearly twice as likely as those with perennial symptoms to be labelled as having rhinitis by their doctor. More than a quarter of the subjects fulfilling our definition of hayfever had not been diagnosed as having hayfever. Subjects from the upper social classes were more likely than those from the lower social classes to be labelled as having hayfever, though there were no significant differences between social classes in the prevalence of hayfever according to our definition. It is concluded that rhinitis is frequently underdiagnosed and misdiagnosed. Increased detection of hayfever could account for the steep rise in consultation rates seen in recent decades.

Adolescent↗
PubMed1991

AIDS: knowledge, skills and attitudes among vocational trainees and their trainers.

In order to assess the adequacy of learning about the human immunodeficiency virus (HIV) and the acquired immune deficiency syndrome (AIDS) in vocational training for general practice, a postal questionnaire survey was carried out among trainers and their trainees in seven health regions of England and Scotland. A total of 616 trainers (62%) and 538 trainees (58%) responded to the questionnaire asking about their knowledge, skills and attitudes regarding HIV and AIDS. Trainees' principal difficulties with HIV and AIDS resembled those of general practitioners currently in practice. More than 60% of trainees lacked knowledge about HIV and AIDS in babies, 50% would not accept intravenous drug misusers onto their list, only 12% found it easy to discuss sex with homosexual male patients, and only 37% felt able to offer counselling about HIV and AIDS. Trainees who had had a tutorial on HIV and AIDS as part of vocational training were significantly more knowledgeable than the remainder (P less than 0.01). In addition, trainees who found workshops on HIV and AIDS useful were more willing than others to take on drug misusers (P less than 0.05) and more confident in their ability to counsel patients with HIV infection (P less than 0.01). No significant associations were found between the trainers' own knowledge, attitudes and skills regarding HIV and AIDS and those of their trainees. It is concluded that there is a need to improve teaching about HIV and AIDS in vocational training for general practice. All general practitioner trainees should receive a tutorial to update their knowledge about HIV and AIDS, and attend a suitable workshop to challenge unfavourable attitudes and improve confidence in counselling.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Birth month variation in atopic and non-atopic rhinitis.

The association of birth month with the development of atopic and non-atopic rhinitis was investigated in 327 adults in south-west London. Birth month was a significant risk factor for both atopic and non-atopic rhinitis in subjects whose age at onset was under 20 yr, but not in those who were older at onset. The odds of being born in May-June were 1.68 (95% CI: 1.03-2.76) for atopic rhinitic subjects and 1.90 (95% CI: 1.11-3.25) for non-atopic rhinitic subjects. The birth month effect was not related to the criteria used to determine subjects' atopic status or to subjects' clinical characteristics, apart from their age at onset. The findings suggest that atopic and non-atopic rhinitis have a common aetiology which does not depend on infant sensitization to seasonal allergens.

Adolescent↗
PubMed1990

A general practice based survey of bronchial hyperresponsiveness and its relation to symptoms, sex, age, atopy, and smoking.

The prevalence and associations of bronchial hyperresponsiveness were investigated in a general practice population. The sample was obtained by using every 12th patient on the practice age-sex register, replacing non-responders with corresponding age and sex matched individuals from up to two further 1 in 12 samples. The response rate was 43%; 366 patients were studied. Doubling concentrations of methacholine were given to a maximum of 32 mg/ml or until a 20% fall in forced expiratory volume in one second (FEV1) occurred (provocation concentration, PC20FEV1). Bronchial hyperresponsiveness was defined arbitrarily as a PC20FEV1 of 2 mg/ml or less (or 11 mumol cumulative dose, PD20FEV1). The prevalence of bronchial hyperresponsiveness was 23%. Bronchial hyperresponsiveness was not associated with age but was more prevalent in women than men (31%:13%). It was also more common in those who had ever wheezed (39%) and in those who had had an attack of rhinitis in the preceding month (45%, p less than 0.1), in atopic individuals (30%), and in smokers (32%), but it was not associated with cough or dyspnoea. There was a positive correlation between PC20FEV1 and resting FEV1 (r = 0.288) and a negative correlation between PC20FEV1 and mean daily peak flow variability (r = -0.356). Stepwise binary logistic regression analysis showed significant independent effects on PC20FEV1 for mean daily peak flow variability, gender, number of positive skin test responses, resting FEV1, and mean histamine skin weal area, but no relation with smoking or mean allergen weal area. The prevalence of bronchial hyperresponsiveness was much higher than the prevalence of diagnosed asthma in the practice in 1984 (4.9%). Analysis of case notes of 169 individuals showed that those with bronchial hyperresponsiveness had not attended the practice more frequently for respiratory complaints during the previous five years.

Adolescent↗
PubMed1990

Is the prevalence of atopy increasing?

There is controversy about whether allergic disease has increased in recent decades. This study compared the prevalence of atopy, as shown by allergy skin prick testing among adults in 1988 (n = 74) with a similar study carried out in 1974 (n = 1359). Both study groups were drawn from the general population in south west London, but the 1988 sample specifically excluded people with rhinitis. The proportion of subjects with at least one positive reaction to a panel of three common allergens increased significantly from 23% in 1974 to 46% in 1988 (P less than 0.01). If allowance was made for the exclusion of rhinitis subjects from the 1988 sample, the current prevalence of atopy may be higher still. The increase in prevalence was significant in older subjects (aged 55-59 years) and women but not in other age groups or in men. This small study raises the possibility that atopy has increased in prevalence in the UK over recent decades and additional studies are needed to evaluate the validity of this hypothesis.

Adult↗
PubMed1989

Patient self care in acute asthma.

Psychosocial and other factors that may affect patient self care in acute asthma were investigated in 210 asthmatic adults recruited from general practice and hospital clinics. Interviews and self complete questionnaires were used to assess patients' management of a hypothetical slow onset and rapid onset attack of asthma, attitudes to asthma, family support, psychiatric morbidity, recent asthma morbidity, and knowledge of drug treatment. The patients with the highest morbidity from asthma delayed longest before taking appropriate action in the hypothetical acute attack. One in four patients expressed strong feelings of stigma and pessimism about being asthmatic, but attitudes were only weakly associated with behaviour. Other factors showed no significant relation to self care. The results suggest that there is no single important factor or group of factors governing patients' management of acute asthma. Health education might therefore prove more effective if it paid less attention to the possible cause or causes of poor self care and instead offered pragmatic advice on changing behaviour.

Acute Disease↗
PubMed1988

Relationship between psychosocial factors and asthma morbidity.

A general practice study was designed to describe certain psychosocial attributes of asthma patients and to relate these to reported asthma morbidity in the previous two years. A postal questionnaire on their respiratory morbidity was completed in September 1983 and again in September 1985 by 207 asthma patients. They then completed a postal questionnaire concerning their attitudes to asthma and level of family support. The findings revealed a marked degree of psychosocial morbidity among patients. Family support showed no significant associations with past or current levels of morbidity, or with changes in morbidity over the previous two years. In contrast, negative attitudes to asthma were correlated with significantly higher levels of morbidity, the strongest associations being found between patients' present attitudes and their most recent level of morbidity. These findings in conjunction with work carried out elsewhere suggest that high levels of asthma morbidity bring about a negative attitude to the condition which in turn contributes towards continuing morbidity.

Adolescent↗
PubMed1988

Measuring patient satisfaction with life in a long-stay psychiatric hospital.

A survey of patient satisfaction with physical and social conditions was carried out in the long-stay wards of a large inner city psychiatric hospital in London, Britain. Patient satisfaction was assessed by means of an administered questionnaire which was developed specifically for this purpose. Factor analysis identified eight components of patient satisfaction. Of 143 eligible patients, 104 (73%) successfully completed the interview. Responses showed that patients were generally satisfied with life in the hospital, although levels of satisfaction varied significantly among wards. The factors causing greatest dissatisfaction related to failure to be treated as individuals and to feelings of isolation and apathy. Our findings showed that patients can express views about their conditions which should be useful in planning improvements in care. The questionnaire proved a simple and effective method of measuring satisfaction and may be useful to others concerned with improving the quality of the environment of patients.

Adult↗
PubMed1988

AIDS and the future general practitioner.

Teaching by example is an essential component of vocational training in general practice and trainers should be expected to exhibit a high standard of practice. A postal questionnaire about knowledge of, attitudes to and response to the epidemic of the acquired immune deficiency syndrome (AIDS) was completed by 114 general practitioner trainers in the south west Thames region. The findings were compared with those of an identical survey of 155 non-trainer general practitioner principals in south west London. There were no appreciable differences between trainers and nontrainers in knowledge and attitudes, although trainers were significantly more likely to have discussed the problem of AIDS with their practice staff. The problems encountered in both groups included: lack of knowledge about AIDS, inability to offer AIDS counselling and advice, and reluctance to care for intravenous drug abusers. These findings suggest that trainers need to improve their practice in areas concerned with the AIDS problem in order to provide a better learning model for their trainees.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Controlled evaluation of the effects of patient education on asthma morbidity in general practice.

Two different patient education programmes for asthma in general practice were evaluated in a controlled trial. Knowledge, self management, and morbidity due to asthma were assessed in 339 patients by means of a questionnaire. One group then received a maximum education programme, a second group received a limited education programme, and a third acted as a control group. 274 patients were reassessed after one 1 year. In both the intervention groups, understanding of asthma was greater after the trial. Only in the maximum intervention group was a significant improvement in knowledge of asthma shown. Neither group showed any change in self-management ability or asthma morbidity that differed significantly from changes in the control group. These simple informational education programmes were ineffective when applied to a general practice population. Further studies of factors affecting attitudes, beliefs, and actions are needed to improve the advice and support given to asthma patients.

Activities of Daily Living↗