Biomedical subjects
Gill Green
Publications and source records attributed to Gill Green.
Is the English National Health Service meeting the needs of mentally distressed Chinese women?
OBJECTIVES: To identify barriers to communication between health care workers and Chinese women living in England, a group who are known to use the National Health Service (NHS) less than other ethnic groups; to consider whether such barriers lead to inequitable access to NHS mental health treatment; and to determine the extent to which this results from institutional racism. METHOD: A purposive sample of 42 Chinese women living in South-East England aged 29-60 years derived from a primary care group, two secondary mental health service providers and three Chinese associations. Subjects had all consulted a general practitioner and had either experienced mental distress (n= 24) and/or had used traditional Chinese medicine (n = 25). RESULTS: Communication with health care professionals was hindered by a lack of common language and an absence of shared concepts concerning the causes and manifestations of health and illness, particularly mental health. This lack of communication resulted in delayed diagnoses, misunderstood treatment regimens and deterred women from (re-)presenting to the NHS. Among our informants, these types of problem were more acute for those women who were most marginalised from English-language culture. CONCLUSIONS: Linguistic and conceptual problems explain Chinese women's relatively poor access to mental health services. The continuing failure to tackle systematically these communication problems through the routine provision of interpretation and advocacy services lays the health care system open to the charge of "institutional racism".
'Inappropriate' attendance at an accident and emergency department by adults registered in local general practices: how is it related to their use of primary care?
OBJECTIVES: To identify the relationship between 'inappropriate' attendance at an accident and emergency department (AED) by adults registered with local general practices and their use of primary care. METHODS: A case-control study matched for age, sex, distance from the AED, social class and registered general practice and set in a single AED and two health centres in South Essex. The participants were a total of 452 patients over 15 years old from the two health centres classified as having attended the AED 'inappropriately' in 1997 as identified by a modified Sheffield process method, and 452 controls. The predictive variables were measures of utilisation in the year 1997, including number of contacts in primary care, referral and investigation costs. Measures of morbidity were collected as potential confounders. These included a recorded history of anxiety or depression in the year 1997, or being in receipt of repeat prescriptions in that year. RESULTS: The rate of 'inappropriate' attendance was 16.8% [95% confidence interval (CI): 15.7-18.0]. All measures of utilisation and markers of anxiety and depression were significantly positively associated with 'inappropriate' attendance, but there was no association with markers of chronic morbidity. Only the number of general practitioner (GP) appointments (P < 0.0001) and out-of-hours advice calls (P < 0.0001) were independently correlated with 'inappropriate' attendance in a conditional logistic regression. 'Inappropriate' attendees had approximately twice as many GP appointments and 10 times as many out-of-hours telephone contacts with the GP. CONCLUSIONS: GP-registered, 'inappropriate' attendees at AEDs utilise primary care services more than matched controls; this pattern of service utilisation appears to be unrelated to chronic physical illness. Thus, simply providing new, directly accessible primary health care services may not significantly reduce AED use.
AIDS and euthanasia.
This paper estimates the proportion of people with HIV who have considered asking assistance to end their lives and explores their motivations and plans of action to hasten death. 16/57 (28%) people with HIV have considered asking for assistance to hasten death, significantly more than seronegative controls (4/67) (3%) (p < 0.001). In follow-up interviews with seropositive respondents the figure increased to 19/57 (33%). The main motivations are fear of being dependent and losing dignity and control in the final stages of the disease. These results are discussed in the light of current legislation about euthanasia and recent evidence that about one-half of NHS doctors would be prepared to comply with requests for euthanasia were it legal to do so.