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Biomedical subjects

D Shickle

Publications and source records attributed to D Shickle.

At least 19 recordsLinked to original sources
PubMed2006

Concerns over confidentiality may deter adolescents from consulting their doctors. A qualitative exploration.

OBJECTIVES: Young people who are concerned that consultations may not remain confidential are reluctant to consult their doctors, especially about sensitive issues. This study sought to identify issues and concerns of adolescents, and their parents, in relation to confidentiality and teenagers' personal health information. SETTING: Recruitment was conducted in paediatric dermatology and general surgery outpatient clinics, and on general surgery paediatric wards. Interviews were conducted in subjects' own homes. METHODS: Semistructured interviews were used for this exploratory qualitative study. Interviews were carried out with 11 young women and nine young men aged 14-17. Parents of 18 of the young people were interviewed separately. Transcripts of tape recorded interviews provided the basis for a framework analysis. RESULTS: Young women were more concerned than young men, and older teenagers more concerned than younger teenagers, about people other than their general practitioner (GP) having access to their health information. Young people with little experience of the healthcare system were less happy than those with greater knowledge of the National Health Service (NHS) for non-medical staff to access their health information. As they grow older, adolescents become increasingly concerned that their health information should remain confidential. CONCLUSION: Young people's willingness to be open in consultations could be enhanced by doctors taking time to explain to them that their discussion is completely confidential. Alternatively, if for any reason confidentiality cannot be assured, doctors should explain why.

Adolescent↗
PubMed2004

An audit of the process of developing the Health Improvement Programme into Strategic and Financial Framework in two health authorities.

Health Improvement Programmes (HImPs) are a means of documenting the health needs of a population and are intended to be translated into commissioning decisions by the Strategic and Financial Framework (SaFF). This paper examines some major influences on the process of translating the HImP into the SaFF. The Directors of Public Health in two Health Authorities were concerned that the development of the SaFF did not always represent a clear progression from the HImP. An audit to pinpoint where commissioning decisions did not match the identified health improvement needs in two Health Authorities was carried out between November 2000 and February 2001. The overall findings confirmed that needs identified in the HImPs were not fully reflected in the service provision described in the final SaFFs. The audit provided evidence that was useful in identifying major issues and influences that facilitated or hindered the development of the SaFF from the HImP. Some of the ways in which HImP priorities disappeared from the SaFF and non-HImP priorities appeared in it were also distinguished. The conclusion is that a clear, criterion-based process should enable health and social care communities and Primary Care Trusts to develop a more responsible commissioning process in future, and specific recommendations to that effect are made.

Health Services Needs and Demand↗
PubMed2001

Travel illness in British package holiday tourists: prospective cohort study.

OBJECTIVES: To examine the relationship between knowledge of travel health matters, health preparation for travel and risk of travel related illness. METHODS: Travellers on holiday charter flights from Cardiff-Wales Airport provided information on holiday preparation before departure and were surveyed 2 weeks after return for details of holiday lifestyle and travel illness. RESULTS: Travellers' diarrhoea was reported by 25.7% of 1469 travellers; 24.4% had sunburn and 7.6% had respiratory infection. Attack rates for travellers' diarrhoea were highest in people aged 15-34 years (34.1%). Rates were higher the shorter the interval between holiday booking and departure (chi(2)for linear trend 13.5, 1df, P <0.001) and lower in travellers who sought advice from their general practitioner before departure (adjusted odds ratio 0.6, 95% confidence interval 0.4-0.9). The most important predictors for travellers' diarrhoea were travel with friends, country of destination, stay in room only or bed and breakfast accommodation, and type of meals most frequently eaten. CONCLUSIONS: Better holiday preparation seems to reduce risk of travel illness, even after adjusting for variables that may reflect the more cautious personality of the traveller. Encouragement to book early, take medical advice and travel well prepared could have a positive health benefit, but intervention studies are required.

Adolescent↗
PubMed2001

Euroscreen 2: towards community policy on insurance, commercialization and public awareness.

The project Euroscreen 2 has examined genetic screening and testing with particular reference to implications for insurance, commercialization through marketing of genetic tests direct to the public, and issues surrounding raising public awareness of these and other developments in genetics, including the practical experiment of a Gene Shop. This paper provides a snapshot of the three year project. The study group's work included monitoring developments in different European countries and exploring possibilities for regulation in insurance and commercialization together with public attitudes to regulation. The success or failure of different strategies is not independent of public awareness. Exploration of policy, however, also requires examination of fundamental concepts such as solidarity and geneticization.

Attitude to Health↗
PubMed2000

"On a supposed right to lie [to the public] from benevolent motives": communicating health risks to the public.

There are three main categories of rationale for withholding information or telling lies: if overwhelming harm can only be averted through deceit; complete triviality such that it is irrelevant whether the truth is told; a duty to protect the interests of others. Public health authorities are frequently having to form judgements about the public interest, whether to release information or issue warnings. In June 1992, routine surveillance detected patulin levels (a known carcinogen) in samples of apple juice exceeding safety threshold. Remedial actions were promptly taken and it was planned to subsequently publish the information in the routine way. However, the media portrayed the handling of the problem as a conspiracy and there was a short term reduction in juice sales. In October 1995, the UK Committee on Safety of Medicines issued a warning about certain brands of the contraceptive pill, based on the interim results of three unpublished studies. The increased risk of thromboembolism was small, but the resulting scare led to an increase in unwanted pregnancies. The handling of the B.S.E. crisis in the U.K. also led to accusations of incompetence or conspiracy. Public health authorities have to handle uncertainty and frequently have to form judgements for public safety on the basis of evidence of poor quantity and quality. Their task is not helped by the sometimes conflicting agenda of scientists and media. The public also have differing perceptions and interpretations of risk. The series of scares and crises are having a detrimental effect on public confidence in public health authorities.

Animals↗
PubMed1999

The 'new genetics' and primary care: GPs' views on their role and their educational needs.

BACKGROUND: Given the limited specialist resources available to cope with the rising demand for genetic services, it has been proposed that at least some of these services are provided by primary care in the future. OBJECTIVE: We aimed to explore GPs' attitudes towards new developments in genetics, to establish the role they envisage for primary care and to clearly define the education, information and training needed to support them in this role. METHODS: We carried out a qualitative study with GPs using four focus groups (26 GPs) and 15 individual semi-structured interviews. RESULTS: GPs perceive genetics as an important and increasingly relevant topic for primary care. Views on the appropriate level of involvement for primary care are mixed. GPs currently lack the relevant knowledge and skills to manage patients concerned about their family history. Other potential barriers to increasing primary care involvement included the time and costs involved, and ethical and legal concerns. CONCLUSION: If primary care is to become more involved in the delivery of genetic services in the future, then a major educational effort is required to raise awareness of the potential scope and limitations of new developments.

Attitude of Health Personnel↗
PubMed1998

Genetic screening and ethics: European perspectives.

Analysis and comparison of genetic screening programs shows that the extent of development of programs varies widely across Europe. Regional variations are due not only to genetic disease patterns but also reflect the novelty of genetic services. In most countries, the focus for genetic screening programs has been pregnant women and newborn children. Newborn children are screened only for disorders which are treatable. Prenatal screening when provided is for conditions for which termination may be offered. The only population screening programs for adults are those for thalassaemia carrier status in Cyprus, Greece and Italy. Social responses to genetic screening range from acceptance to hostility. There is a fundamental tension between individual and community in the debates in various European countries about implementation of screening programs. Opposition to genetic screening is frequently expressed in terms of arguments about "eugenics" with insufficient regard to the meaning of the term and its implications. Only a few countries have introduced explicit legislation on genetic screening. Legislation to address discrimination may provide more safeguards than legislation protecting genetic information itself.

Adult↗
PubMed1998

Travel brochures need to carry better health advice.

Most people travelling abroad on holiday from the United Kingdom consult a travel brochure and book with a travel agent. Travel brochures are therefore potentially an important source of travel health advice. We assessed the quantity and quality of health advice of 143 travel brochures for 1994/5 winter and 1995 summer seasons available from a high street travel agent. Only 11% carried health information in a prominent location, 64% put health information at the end (often in small print), and 25% contained no health information at all. Much advice was superficial, and only a minority mentioned safe drinking water (24%), safe food (22%), or safe sex (3%). Better health advice more prominently displayed is needed in travel brochures. Public health practitioners should collaborate with travel companies and travel agents to improve the quality and quantity of health information provided to travellers.

Communicable Disease Control↗
PubMed1997

Carrier screening for cystic fibrosis in primary care: evaluation of a project in South Wales. The South Wales Cystic Fibrosis Carrier Screening Research Team.

Population carrier screening for cystic fibrosis (CF) was offered to all patients aged 16-45 in one general practice in South Wales, excluding those in couples with a current pregnancy. Out of 1553 patients in this group, 481 subjects were tested, giving an overall uptake rate of more than 30%. The rate of uptake varied with the mode of invitation. Twenty-six carriers were identified, giving a prevalence of identified carriers of 5.4% (1 in 18.5) for those with no family history of CF. A further 18 carriers were identified by cascade testing of these 26. We describe the practical difficulties encountered in setting up this programme in primary care in South Wales. Questionnaires were administered or distributed to all subjects before and after testing. The response rate for the pre-test questionnaire was 95%, and 40-50% for the post-test questionnaires. These showed that, at 3 months post-test, 1 in 4 screen-negative subjects did not appreciate that they had a residual risk of being a carrier. At the same time, 15% of this group thought that there was a 1 in 4 chance of a child being affected if one parent was screen-positive (carried an identified mutation) and the other was screen-negative, and 40% thought there was no risk. Anxiety in relation to testing did not appear to be a major problem, although individual patterns of response to carrier status varied widely and more sensitive indicators of psychosocial impact of genetic tests are required. A pilot study of couple screening showed that this approach is unlikely to be useful in primary care, although we did not assess couple testing during pregnancy. For any programme of CF carrier screening to be established in primary care, it will be necessary to involve the primary care team from the earliest planning stage, so that the opportunity costs, training needs and other costs of the programme can be fully resourced.

Adolescent↗
PubMed1995

Rugby injuries.

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Adolescent↗
PubMed1994

The ethics of screening: is 'screeningitis' an incurable disease?

Screening programmes are becoming increasingly popular since prevention is considered 'better than cure'. While earlier diagnosis may result in more effective treatment for some, there will be consequent harm for others due to anxiety, stigma, side-effects etc. A screening test cannot guarantee the detection of all 'abnormal' cases, therefore there will be false reassurance for some. A proper consideration of the potential benefit and harm arising from screening may lead to the conclusion that the programme should not be offered. A modified utilitarian approach may be used for allocation of scarce resources in health care. Ethics has an important role in this evaluation.

Attitude to Health↗
PubMed1993

Simply sausages?

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Contract Services↗
PubMed1993

'Inside-out', back-to-front: a model for clinical population genetic screening.

Developments in DNA technology have resulted in a dramatic increase in the number of genes identified. With the localisation of a gene it is possible to devise procedures suitable for mass carrier screening programmes. Until recently mass carrier screening was only possible for a limited number of disorders, for example, Tay-Sachs disease and haemoglobinopathies. Counselling possible carriers was based on estimations of risk. The momentum towards mass carrier screening is likely to be increased by gene therapy. Carrier screening for cystic fibrosis alone will have dramatic implications for genetic service provision as 4 to 5% of the UK population carry the CF gene. The potential for genetic screening of multifactorial diseases, for example, cancers, should also be considered. The existing organisation of genetic services is likely to be inadequate. A new specialty of clinical population genetics is required. A model is proposed of clinical population genetic screening programmes, organised under a 'common umbrella' led by a public health physician, while screening and follow up will remain the responsibility of the appropriate clinician.

Female↗
PubMed1989

Knowledge and perceptions of haemoglobinopathy carrier screening among general practitioners in Cardiff.

A questionnaire was sent to 164 principal general practitioners working in Cardiff. A response rate of 81% was achieved. A total of 70% of respondents had had professional contact with a carrier for thalassaemia and a similar number for sickle cell disease, while 57% had recommended that a patient should be screened for haemoglobinopathy status. GPs tended to underestimate greatly the prevalence of haemoglobinopathies in South Glamorgan, and were uncertain of the ethnic minorities that were at particular risk. A carrier screening programme was considered justified by the majority of GPs in Cardiff and reasons for this opinion were examined. However, before a screening programme is started, information on whom to screen and their relative risk needs to be made more widely available.

Attitude of Health Personnel↗