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Biomedical subjects

C Godfrey

Publications and source records attributed to C Godfrey.

At least 37 records · Page 2Linked to original sources
PubMed2000

The Gatehouse Project: a systematic approach to mental health promotion in secondary schools.

OBJECTIVE: The objective of this paper is to outline the conceptual background and strategy of intervention for a systematic and sustainable approach to mental health promotion in secondary schools. METHOD: The conceptual origins of the Gatehouse Project are described in terms of the epidemiology of adolescent mental health problems, attachment theory, education reform research and health promotional theory and practice. The elements of health promotional work are described in terms of structural change and priority setting; implementation at multiple levels within the participating schools is described. RESULTS: The conceptual framework of the Gatehouse Project emphasises healthy attachments with peers and teachers through the promotion of a sense of security and trust, effective communication and a sense of positive self-regard based on participation in varied aspects of school and community life. A school social climate profile is derived from a questionnaire survey of students. An adolescent health team uses this information to set priorities for change within the school. Interventions may focus on the promotion of a positive social climate of the whole school or in the classroom. Curriculum-based health education is also used and based on materials that are relevant to the normal developmental experiences of teenagers. These are integrated into the mainstream curriculum and incorporate a strong component of teacher professional development. Lastly, the intervention promotes linkage between the school and broader community with a particular emphasis on the needs of young people at high risk of school drop-out. CONCLUSIONS: Educational environments are complex systems undergoing continuous and simultaneous changes. The Gatehouse Project will provide unique information on the relationship between the social environment and the emotional wellbeing of young people. More importantly it outlines a sustainable process for building the capacity of schools to promote the social and emotional development of young people.

Adolescent↗
PubMed2000

Costs of employee smoking in the workplace in Scotland.

BACKGROUND: Employers have responded to new regulations on the effects of passive smoking by introducing a range of workplace policies. Few policies include provision of smoking cessation intervention. OBJECTIVE: To estimate the cost to employers of smoking in the workplace in Scotland to illustrate the potential gains from smoking cessation provision. Costs vary with type of smoking policy in place; therefore, to estimate these costs results from a survey were combined with evidence drawn from a literature review. STUDY DESIGN: A telephone survey of 200 Scottish workplaces, based on a stratified random sample of workplaces with 50 or more employees, was conducted in 1996. Additional evidence was compiled from a review of the literature of smoking related costs and specific smoking related effects. RESULTS: 167 completed responses were received, of which 156 employers (93%) operated a smoking policy, 57 (34%) operated smoke free buildings, and 89 (53%) restricted smoking to a "smoke room". The research literature shows absenteeism to be higher among smokers when compared to non-smokers. The estimated cost of smoking related absence in Scotland is pound40 million per annum. Total productivity losses are estimated at approximately pound450 million per annum. In addition, the resource cost in terms of losses from fires caused by smoking materials is estimated at approximately pound4 million per annum. In addition, there are costs from smoking related deaths and smoking related damage to premises. CONCLUSION: This study shows how smoking cessation interventions in the workplace can yield positive cost savings for employers, resulting in gains in productivity and workplace attendance which may outweigh the cost of any smoking cessation programme.

Absenteeism↗
PubMed1999

Occult bladder injury during laparoscopy: report of two cases.

Bladder injuries occur in approximately 1.6% of all laparoscopic procedures. Most often, these injuries are recognized intraoperatively or immediately postoperatively because of gross hematuria. We report two cases of bladder injury related to placement of suprapubic laparoscopic trocars that were not recognized at the time of surgery and in which no gross hematuria was evident. In each case, the patient had a history of abdominal surgery, and the diagnosis was difficult to make. The treatment was prolonged catheterization in one patient and laparotomy through a midline incision in the other. Strategies are discussed for minimizing the risk of bladder injury during laparoscopic trocar placement and for diagnosing and treating injuries.

Adult↗
PubMed1998

Alternative health care: its use by individuals with physical disabilities.

OBJECTIVE: This research investigated the use of alternative therapies by individuals with physical disabilities. DESIGN: A telephone survey of a cross-sectional convenience sample of people with disabilities. SETTING: An urban, outpatient rehabilitation facility specializing in vocational services. PARTICIPANTS: A convenience sample of 401 working-age individuals. MAIN OUTCOME MEASURE(S): Self-reported use of alternative therapy. RESULTS: More of this sample of individuals with physical disabilities than a randomized, national sample of the general population used alternative therapies (57.1% vs 34%) and saw providers of those therapies (22% vs 10%). Among individuals in the current sample, significant positive relationships between use of alternative therapies and education and income levels were discovered. The use of alternative therapies by this sample, however, was not associated with racial identity, gender, or age. Compared with the general population, this study's respondents reported a higher proportion of chronic pain (14% vs 8%) and depression (14% vs 8%), and a lower proportion of severe headache (9.2% vs 13%). Alternative therapies were chosen more often than conventional therapies by those with physical disabilities for pain (51.8% vs 33.9%), depression (33.9% vs 25%), anxiety (42.1% vs 13.1%), insomnia (32.3% vs 16.1%), and headaches (51.4% vs 18.9%). CONCLUSION: Physically disabled individuals are more likely to use alternative therapies than the general population and to see providers for them, have their use recommended by their physicians, and be reimbursed by their health insurance for them. A high prevalence of dysphoria is found among those with disabilities, for which a combination of alternative and conventional therapies is often used.

Adolescent↗
PubMed1998

The population pharmacokinetics of long-term methotrexate in rheumatoid arthritis.

AIMS: Methotrexate is considered by many practitioners to be the agent of choice in the treatment of rheumatoid arthritis. The pharmacokinetics of methotrexate have been reported to exhibit significant intersubject variability. Therefore, this study was undertaken to evaluate the population pharmacokinetics of methotrexate during long-term administration in adults with rheumatoid arthritis. METHODS: Methotrexate pharmacokinetics were evaluated in a 36 month study of 62 adults with rheumatoid arthritis. Patients received oral or intramuscular doses of methotrexate weekly with pharmacokinetic studies performed every 6 months. Data were analyzed with nonlinear mixed effects modeling. RESULTS: Three thousand two hundred and sixty post oral or intramuscular dose serum methotrexate concentrations comprising 425 individual concentration vs time profiles were modeled using NONMEM. Covariates that significantly (P < 0.005) influenced the disposition of methotrexate were age (AGE, years), body weight (BW, kg), creatinine clearance (CL(CR), 1 h(-1)), gender (GEN; 0 = male, 1 = female), dose (DOSE, micromol), and fed vs fasted state (FED; 0 = fasted, 1 = fed). The final model describing the biexponential disposition of methotrexate was clearance(CL, 1 h(-1)) = (0.0810*BW + 0.257*CL(CR))*(1-(0.167*GEN); central volume (Vc, 1) = 0.311*BW; peripheral volume (Vp, 1) = 0.469*BW-0.169*AGE; intercompartmental clearance (Q, 1 h(-1)) = 4.27*(1-0.355*GEN); oral absorption rate constant (ka(p.o.), h(-1)) = 4.70-0.0439*DOSE*(1-0.507*FED); intramuscular absorption rate constant (ka(i.m.), h(-1)) = 0.122*DOSE; relative bioavailability (F) = 93.4%; and oral absorption lag time (LAG(p.o.), min) = 13.5. Pharmacokinetic parameters (%CV) for a typical fasted male subject in this study were CL, 7.341 h(-1) (27%); Vc, 23.51 (28%); Vp, 25.31 (31%); Q, 4.25 1 h(-1) (41%); ka(p.o.), 3.67 h(-1) (77%); and ka(i.m.), 3.09 h(-1) (44%). CONCLUSIONS: The population pharmacokinetics of methotrexate in adults with rheumatoid arthritis were well described by this investigation. Substantial interpatient variability was explained by incorporating patient specific data into regression equations predicting pharmacokinetic parameters.

Adult↗
PubMed1998

Economic burden of drug dependency. Social costs incurred by drug users at intake to the National Treatment Outcome Research Study.

BACKGROUND: The use of illegal drugs is seen as a major social problem. The social costs can be high. METHODS: Self-report data from interviews at intake to the National Treatment Outcome Research Study (NTORS) for 1075 drug users and cost data from various sources were used to estimate criminal behaviour and health and addiction service costs for a 12-month period. Multivariate statistical analysis was used to analyse cost variations. RESULTS: Total costs for one year for the drug users amounted to over 12 million Pounds, the majority attributable to self-reported criminal behaviour. Social costs were positively related to a variety of factors including instability in living circumstances, amount of heroin used and whether or not drugs were taken intravenously. CONCLUSIONS: The study clearly demonstrates the economic and social burden associated with heavy drug users and highlights the need for further investigations into the costs and benefits of policies that can reduce these social costs.

Age Factors↗
PubMed1997

Lost productivity and costs to society.

Having a single monetary amount that provides an indicator of alcohol misuse can be a powerful instrument for those advocating policy action. Existing studies suggest that alcohol use in any year may yield costs that are equivalent to 2-5% of the gross national product. While useful, such figures do not indicate which combinations of policies could yield the greatest net benefits for their populations. There may also be interest in the effects of alcohol use on public finances or the fairness of both taxes and welfare payments across different groups of the population. Which items are identified as being relevant and how these effects are measured and valued will depend on which policy question is being addressed. There are, however, a number of common issues such as whether costing studies should be confined to the heaviest and problematic, how benefits of alcohol consumption should be measured, how future benefits in terms of health gains should be valued and whether the costs to the drinker are important or only those costs which are borne by third parties. There will not always be simple answers to these questions. However, even if costing studies are confined to third party effects and the most conservative assumptions are taken, it is clear that there is powerful evidence that many societies would be better off if action is taken to prevent alcohol problems. Research on the effects of alcohol use is becoming increasingly sophisticated and this will lead to improvements in costing studies. Productivity losses are likely to remain one of the most significant costs of alcohol misuse.

Accidents↗
PubMed1997

Costing substance misuse services.

AIMS: To develop a methodology for obtaining the detailed costs of different substance misuse services and illustrate some of the specific problems by means of a case study. DESIGN: Data on the resources required, clinical activity, and patient characteristics for one year were combined to provide detailed costs for different types of clinical events and patients. SETTING: The clinical services of a publicly funded addiction unit in a large industrial city in the UK. The unit provides for alcohol and other drug misusers mainly on an outpatient basis but with inpatient care. PARTICIPANTS: Over 1500 patients were included in the analysis with 75 per cent being male, and 80 per cent aged between 20 and 49. Nearly half of the clients had alcohol as their main drug of misuse with opiate users being the next largest group. MEASUREMENT: Detailed costing by event and patient was possible as the staff type and time taken for each event were routinely recorded. A cost for each individual event was estimated and summed for each individual patient to give a cost estimate by patient for the financial year 1992/3. FINDINGS: Core treatment outpatient events had an average cost of Pounds 48, with new assessments costing Pounds 87 but these averages hid high variations. The average cost per year for those receiving only outpatient care was Pounds 358; it was Pounds 1857 for those receiving both outpatient and inpatient care. Opiate misusers were on average more costly than alcohol misusers. The costs were skewed with 10 per cent of patients accounting for 56 per cent of the total annual costs. CONCLUSIONS: Dealing with costs of non attendance, including all resource use, and coping with large individual variations in costs across individuals and intervention types are the main problems in devising cost figures. Cost data are useful but need to be combined with outcome data if they are to be used to improve patient services.

Adult↗
PubMed1996

Economic and other views of addiction: implications for the choice of alcohol, tobacco and drug policies.

It is the aim of this paper to provide an overview of developments in implicit and explicit economic views of addiction, to contrast these perceptions with the views of other disciplines and discuss the implications for policy. Addictive behaviours have received considerable attention from disciplines other than economics. The nature of addiction and the contribution of psychological, physiological and social factors have been strongly debated within the addictions field for many years. The views of economists are becoming increasingly important because economic studies of consumption, and tax revenue in the case of licit drugs, are one factor when framing policy. It is therefore crucial to know how economists have treated addiction. Have they neglected it and what are the implication if they have? This paper attempts to answer this question by reviewing and discussing the literature in depth and drawing out the implications for policy.

Journal Article↗
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↗
PubMed1995

Counting the costs of children's smoking.

The recent publication of the 1994 OPCS survey of smoking among secondary school children confirmed that the Health of the Nation target for children's smoking (a reduction in regular smoking from 8% in 1988 to less than 6% in 1994) has not been achieved. In 1994, 12% of English schoolchildren aged 11-15 were regular smokers (as were 12% in Scotland, 9% in Wales, and 12.5% in Northern Ireland). In 1994 the government spent around 10 million pounds on initiatives to prevent smoking, but received around 8643 million pounds in tax receipts from tobacco sales, about 108 million pounds of which was tax receipts from the illegal sale of cigarettes to children under 16 years old. The tobacco industry spent an estimated 100 million pounds on promotional activities. Improving current trends in children's smoking by the year 2000 will require decisive action by the government. The government should legislate to ban tobacco advertising and should use the 108 million pounds taken each year in taxes from smoking children to fund smoking cessation and prevention initiatives.

Adolescent↗
PubMed1995

Executive leave: avoiding the pitfalls.

A leave of absence must be carefully planned to avoid any potential pitfalls. A successful transfer of power when assigning a temporary replacement requires trust, confidence and excellent communication. A director and an assistant director who work with over 300 staff share their experience.

Humans↗
PubMed1994

Alcohol policy--evaluating the options.

All policy interventions have costs and benefits and the 'harm' created by the use of alcohol can only be mitigated at a cost. The purpose of economic analysis is to measure these costs and benefits in an explicit way and to use these results to inform policy. Policy makers like to use estimates of the social costs of alcohol use but such data are of little use in identifying which interventions reduce harm at least cost: knowing alcohol use costs in local currencies $6 million in Australia, $5.8 billion in the USA, $5.7 billion in Canada and $2 billion in the UK may fuel political debate but does not identify the intervention where investment produces the greatest increase in benefit at least cost. Integrated policies to raise taxes in relation to price and income changes have significant impacts on alcohol consumption and, if complemented with advertising controls and limits on availability have even larger effects. The quantity and quality of economic evaluations of health care interventions is inadequate. What little evaluation that has been undertaken indicates that low cost minimal interventions may be cost effective for the wider population of problem drinkers. Other more intensive interventions are likely to be cost effective only if well targeted on appropriate client groups. There are many effective ways of reducing alcohol consumption. The industry will lose and oppose change but improvements in health and other aspects of life (eg civil order) will be significant.

Alcohol Drinking↗
PubMed1994

Downsizing: coping with personal pain.

A new emphasis on primary and preventive care is hailed as long overdue by many in nursing. One effect of this paradigm shift, however, is being experienced in many hospitals. Acute-care facilities are rearranging services ("restructuring"), consolidating programs and eliminating large numbers of staff ("downsizing") in an effort to position themselves securely for the future. Downsizing can be devastating to those who lose jobs, so nurse managers and administrators can play a key role in planning the downsizing process sensitively. Whenever possible, loss of a traditional job should be balanced by the offer of a new opportunity within the healthcare system.

Adaptation, Psychological↗