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Biomedical subjects

F Griffiths

Publications and source records attributed to F Griffiths.

15 recordsLinked to original sources
PubMed2005

Health professionals, their medical interventions and uncertainty: a study focusing on women at midlife.

Health professionals face a tension between focusing on the individual and attending to health issues for the population as a whole. This tension is intrinsic to medicine and gives rise to medical uncertainty, which here is explored through accounts of three medical interventions focused on women at midlife: breast screening, hormone replacement therapy and bone densitometry. The accounts come from interviews with UK health professionals using these medical interventions in their daily work. Drawing on the analysis of Fox [(2002). Health and Healing: The public/private divide (pp. 236-253). London: Routledge] we distinguish three aspects of medical uncertainty and explore each one of them in relation to one of the interventions. First is uncertainty about the balance between the individual and distributive ethic of medicine, explored in relation to breast screening. Second is the dilemma faced by health professionals when using medical evidence generated through studies of populations and applying this to individuals. We explore this dilemma for hormone replacement therapy. Thirdly there is uncertainty because of the lack of a conceptual framework for understanding how new micro knowledge, such as human genetic information, can be combined with knowledge of other biological and social dimensions of health. The accounts from the bone denistometry clinic indicate the beginnings of an understanding of the need for such a framework, which would acknowledge complexity, recognising that factors from many different levels of analysis, from heredity through to social factors, interact with each other and influence the individual and their health. However, our analysis suggests biomedicine continues to be dominated by an individualised, context free, concept of health and health risk with individuals alone responsible for their own health and for the health of the population. This may continue to dominate how we perceive responsibilities for health until we establish a conceptual framework that recognises the complex interaction of many factors at macro and micro level affecting health.

Absorptiometry, Photon↗
PubMed2004

Setting priorities and identifying barriers for general practice research in Europe. Results from an EGPRW meeting.

BACKGROUND: In spring 2002, WONCA Europe, the European Society of General Practice/Family Medicine and its Network organizations reached consensus on a 'new' European definition of general practice. Subsequently, the European General Practice Research Workshop (EGPRW) started working on a European General Practice Research Agenda. This topic was addressed during the 2002 EGPRW autumn meeting. OBJECTIVE: Our aim was to explore the views of European general practice researchers on needs and priorities as well as barriers for general practice research in Europe. METHODS: In seven discussion groups, 43 general practice researchers from 18 European countries had to answer the following questions. (i) What major topics should be included in a research agenda for general practice in your country? (ii) What are the barriers to adequate implementation of general practice research in your country? Group answers were listed and subsequently categorized by two authors. RESULTS: Research on 'clinical issues' (common diseases, chronic diseases, etc.), including diagnostic strategies, was considered to be the core content of general practice research, with primary care-based morbidity registration essential for surveillance of disease, clinical research and teaching in general practice. There was also consensus on the need for research on education and teaching. 'Insufficient funding opportunities' was perceived to be the major barrier to the development of general practice research. CONCLUSIONS: These findings could be used as a basis for national checklists of 'content of' and 'conditions for' general practice research. European general practice research training programmes should be developed further.

Communication Barriers↗
PubMed2001

Reflections from organization science on the development of primary health care research networks.

In the UK, policy changes in primary health care research and development have led to the establishment of primary care research networks. These organizations aim to increase research culture, capacity and evidence base in primary care. As publicly funded bodies, these networks need to be accountable. Organizational science has studied network organizations including why and how they develop and how they function most effectively. This paper draws on organizational science to reflect on why primary care research networks appear to be appropriate for primary care research and how their structures and processes can best enable the achievement of their aims.

Communication↗
PubMed2000

The productivity of primary care research networks.

Primary care research networks are being publicly funded in the United Kingdom to promote a culture of research and development in primary care. This paper discusses the organisational form of these networks and how their productivity can be evaluated, drawing on evidence from management science. An evaluation of a research network has to take account of the complexity of the organisation, the influence of its local context, and its stage of development. Output measures, such as number of research papers, and process measures, such as number of research meetings, may contribute to an evaluation. However, as networking relies on the development of informal, trust-based relationships, the quality of interactions within a network is of paramount importance for its success. Networks can audit and reflect on their success in promoting such relationships and a more formal qualitative evaluation by an independent observer can document their success to those responsible for funding.

Efficiency, Organizational↗
PubMed1999

Women's control and choice regarding HRT.

The promotion and use of hormone replacement therapy (HRT) is the focus of much medical activity and a social phenomenon studied by sociology. The decision to prescribe HRT by a doctor may be a response to a woman's distress and is a decision involving uncertainty about risks and benefits. Sociological analysis has seen the promotion and use of HRT as medicalisation of the menopause. Through individual interviews and focus groups, this study hears from women how they approach the decision to take HRT or not, and what influences them. The interviews reveal how women who dislike medication in general may consider HRT, influenced by fear of ill health which may be enhanced by the experience of illness in the family and by medical advice. For the women the media and their social contacts were the major sources of information about HRT. In the focus groups the women explored the control they had over the choice to take HRT and what limited this control and they explored the uncertainties and complexities of the decision to take HRT or not. This study brings lay women's voices to the debate about the use and promotion of HRT. The results are also used to test the limits of the theory of medicalisation and to inform doctors of the issues women may bring to a consultation about HRT.

Adult↗
PubMed1998

General practice and the new science emerging from the theories of 'chaos' and complexity.

This paper outlines the general practice world view and introduces the main features of the theories of 'chaos' and complexity. From this, analogies are drawn between general practice and the theories, which suggest a different way of understanding general practice and point to future developments in general practice research. A conceptual and practical link between qualitative and quantitative methods of research is suggested. Methods of combining data about social context with data about individuals and about biomedical factors are discussed. The paper emphasizes the importance of data collected over time and of considering the multiplicative interactions between variables. Finally, the paper suggests that to develop this type of research, general practice many need to reassess systems of categorizing and recording appropriate data.

Data Collection↗
PubMed1995

Women's health concerns. Is the promotion of hormone replacement therapy for prevention important to women?

The objectives of this study were to find out women's health concerns for the community and for themselves as they age and whether the promotion of hormone replacement therapy for prevention is important to them. A postal questionnaire was sent to 1649 women aged 20-69 years. The sample was random but stratified for age and taken from the lists of eight general practices in the town of Stockton-on-Tees in north east England. The questionnaire included questions on priorities for health care, fears for personal health with ageing, knowledge about osteoporosis, cardiovascular disease and hormone replacement therapy. A 74.3% response rate was achieved. Cancer was named as deserving highest priority for health care in Britain today by 40.7% of respondents. The promotion of long term hormone replacement therapy was given a relatively low priority. The health problem women named as the one they most fear will affect them as they age was, for 30.2% of women, cancer; for 18.8% of women, dementia; for 11.6% of women, arthritis; for 8.8% of women, heart disease. The role of oestrogen in preventing osteoporosis was known by 74.9% of respondents and its role in prevention of cardiovascular disease by 6.6%. Lack of exercise as a risk factor for osteoporosis was known by 29.0% and as a risk factor for cardiovascular disease by 84.6%. Arthritis-like pain was thought to be a warning sign of osteoporosis by by 55.8% of respondents. The promotion of hormone replacement therapy for prevention does not appear to be a high priority for women.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

The use of hormone replacement therapy; results of a community survey.

Hormone replacement therapy is used for both menopausal symptoms and in prevention, but for the latter to be effective there may be a need to promote its use. Suitable strategies need to be informed by current practice. A postal questionnaire was therefore sent to 1649 women aged 20-69 years in Stockton-on-Tees to assess which women consider and take hormone replacement therapy. The response rate was 74%. Therapy had been considered by 346 (28%) women of whom 164 (47%) were premenopausal. It was taken by 20% of women aged 45-65 years. Users were more likely to have taken the contraceptive pill. Use of therapy by women with osteoporosis or cardiovascular disease, or with a family history of these, was low. As women used to the idea of taking hormone replacement therapy and accustomed to taking the contraceptive pill reach menopausal age there is likely to be an increase in uptake of therapy. By targeting the 'at risk' groups of women, the primary care team may be able to make most effective use of the therapy and their own resources for the prevention of osteoporosis and cardiovascular disease.

Adult↗
PubMed1995

Women's decisions about whether or not to take hormone replacement therapy: influence of social and medical factors.

BACKGROUND: General practitioners have been described as reluctant to prescribe hormone replacement therapy although its use is widely discussed and advocated in the popular media. AIM: This study set out to identify women's perceptions of media coverage of hormone replacement therapy; the people influencing women's decisions about therapy and women's sources of information; their general practitioners' attitudes to therapy; and women's experiences of the primary health care team in relation to hormone replacement therapy. METHOD: In 1993, a postal questionnaire survey was undertaken of 1649 women aged between 20 and 69 years registered with eight general practices in Stockton-on-Tees. RESULTS: A total of 1225 women (74%) returned questionnaires. Women considered that the media portrayed mainly positive images of hormone replacement therapy. A substantial minority of women found the media information unhelpful (30%) or felt that it was incorrect (17%). General practitioners and practice nurses were most frequently considered to be the most important people in helping women decide about taking therapy, but relatives and friends were also important; 41% of women named no one. The media, friends and relatives were most commonly cited as the main sources of information about therapy. Of the women who had discussed hormone replacement therapy with their general practitioner, 65% felt that their general practitioner was in favour of its use for relieving menopausal symptoms. Two thirds of women felt they had had enough time and information when discussing hormone replacement therapy with their general practitioner and/or practice nurse. CONCLUSION: Women did not seem to perceive any resistance from their general practitioner to the prescribing of hormone replacement therapy. Although women gathered information about therapy from sources other than their doctor, doctors have an important role, as providers of the therapy, in listening to women and helping them to make their own decision about whether or not to take hormone replacement therapy.

Adult↗
PubMed1995

Women's use of hormone replacement therapy for relief of menopausal symptoms, for prevention of osteoporosis, and after hysterectomy.

BACKGROUND: Hormone replacement therapy is used for the relief of menopausal symptoms. In the United Kingdom, guidelines have been developed for the use of hormone replacement therapy in the prevention of osteoporosis, and in the United States of America its use has also been recommended for cardiovascular disease prevention. However, compliance has been found to be a problem, and rates of prescribing vary between general practitioners. AIM: This study set out to describe the prescribing of hormone replacement therapy in one general practice, to enable doctors to plan future prescribing and promotion of hormone replacement therapy, taking into account constraints on its use. METHOD: The patient records of users of hormone replacement therapy were examined to collect data on menopausal status, reason for use, length of use, breaks from therapy and reasons for stopping therapy. Women with a history of hysterectomy and with risk factors for osteoporosis were identified from the practice morbidity register. Their use of hormone replacement therapy was recorded. RESULTS: Of women aged 40-59 years on the practice list, 348 were taking hormone replacement therapy (20%). Of 107 women aged under 52 years who had had a hysterectomy and bilateral oophorectomy 76 were taking therapy (71%). Of 158 women under the age of 52 years who had had a hysterectomy with preservation of the ovaries 39 were taking therapy (25%). Among women taking hormone replacement therapy for the relief of menopausal symptoms, the highest rate of use was among those aged 50-54 years where 93 were on therapy (24% of women in that age group in the practice). Twenty out of 47 women with a recorded risk factor for osteoporosis were taking therapy. More than three quarters of women using hormone replacement therapy appeared to be taking it continuously. CONCLUSION: The uptake of hormone replacement therapy was found to be high for women with a surgical menopause, the group most easily identifiable as at risk of osteoporosis. Women who decided to take therapy appeared to take it continuously, and therefore effectively for prevention. Rate of uptake, rather than compliance, is more likely to constrain its use in prevention.

Adult↗