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Biomedical subjects

H Carter

Publications and source records attributed to H Carter.

At least 19 recordsLinked to original sources
PubMed1998

Characteristics of responders and non-responders in an infant feeding study.

BACKGROUND: Few studies have fully investigated and described the characteristics of non-responders in infant breast feeding studies. Examination of the characteristics of non-responders enhances this understanding and provides information on the representativeness of the sample actually investigated. METHODS: As part of a larger local longitudinal study, couples whose babies were due to be born during the three months of the study in the autumn of 1995, at two local maternity hospitals, were approached by midwives to participate in the study of infant feeding patterns and determinants, including interviews, questionnaires and postal survey. From the 648 eligible mothers, 91 (14 per cent) were not approached, 233 (35.9 per cent) consented but were not interviewed, 256 (39.5 per cent) consented and were interviewed and 68 (10.5 per cent) refused to participate (non-responders) in the longitudinal study. To make a comparison between the 'responders' (i.e. the 233 who consented but were not interviewed and the 256 who consented and were interviewed) and non-responders (the 68 who refused to consent), appropriate data were collected on their socio-demographic characteristics, their feeding intentions and their feeding behaviour. RESULTS: Univariate analysis revealed a number of significant differences between responders and non-responders. However, log-linear analysis of these differences indicated that the main factors that differentiated between responders and non-responders were social class, smoking habit and actual feeding behaviour. When comparing the feeding intention at the time of 'booking', the non-responders compared with the responders were less likely to intend to breastfeed and more likely to be uncertain about their feeding intentions. Following delivery non-responders compared with responders were more likely to bottle feed their babies. By the time of discharge, of the non-responders, 83.6 per cent were bottle feeding in comparison with 47.3 per cent of responders who were also bottle feeding. CONCLUSIONS: In this study non-responders were found to be more similar to bottle-feeding responders than to breastfeeding responders. Furthermore, non-responders were more likely to be smokers, from lower social class and to bottle feed. This study also showed that the non-responders were more undecided about their feeding intention at the time of the booking visit. Invariably a higher percentage of mothers who were undecided at the booking visit chose to bottle feed their babies at discharge. These results highlight the impact of failing to include information from non-responders when conducting research which examines patterns of infant breastfeeding and attitudes towards it.

Adult↗
PubMed1998

Health professionals' responses to multiple sclerosis and motor neurone disease.

This study compares the responses of health professionals to multiple sclerosis (MS) and motor neurone disease (MND) in order to determine similarities and variations in responses to the two disorders and the issues critical to caring for patients with these conditions. Health professionals were more negative about MND compared with MS in terms of the amount they felt able to offer patients, their confidence in managing patients and their ability to convey hope. For a number of issues concerning the management of patients, the level of difficulty experienced by health professionals was similar for both MS and MND. These were resource issues, the health professionals' ability to remain positive in the face of progressive disability, interdisciplinary team problems and difficulties regarding patient care. The main concern of health professionals, for both conditions, was the effect of progressive disability on the patient. For MND, management issues which health professionals found comparatively more difficult than for MS were patients' short prognosis and impending death, communication problems and progressive disability. Issues which were comparatively more difficult for MS than MND were changes in patients' affect, cognition and personality, problems with planning care because of the disorder's unpredictable course, problems with diagnosis such as making and disclosing the diagnosis, and the tendency for patients to be difficult or demanding. Some notable differences in responses between health professionals in different health care settings were found. The findings have implications for changing health professionals' conceptualization of 'hope', developing ways of improving communication between health professionals in different health care settings so as to enable them to learn from each other's expertise and experiences and redressing gaps in service provision, especially for young people with MS.

Attitude of Health Personnel↗
PubMed1997

Profiling the care needs of the population with dementia: a survey in central Scotland.

OBJECTIVE: To demonstrate a low-cost method of producing local information for dementia service planning. DESIGN: (1) Multiservice census. (2) Stratified random sample survey (stratified by setting) to assess needs. SETTING: All community and institutional settings in Forth Valley Health Board area. PARTICIPANTS: (1) People age 65 + defined by health and social care professionals as having 'problems of memory/confusion (as is caused by dementia)' (N = 2060). (2) As (1) excluding those with score < 2 on Levin's checklist and no relevant known diagnosis (N = 286). MAIN OUTCOME MEASURES: Coverage of population with dementia against EURODEM prevalence. Place of residence of sufferers. Level of care needs. MAIN RESULTS: Identified population, pro-rating for identifiable non-response, accounted for 78% of EURODEM prevalence. Assuming unidentified 22% to live at home, 45% of total population with dementia were in some form of institutional care. Survey demonstrated high levels of need in local population with dementia known to services. Assistance was required more than once a day with mobility by 48%, personal care by 60%, domestic tasks by 75% and because of behavioural problems by 57%. Assistance was required at night by 59% because of personal care needs and by 54% because of behaviour problems. CONCLUSIONS: The value of a broad-based survey 'snapshot' across the range of settings was confirmed. It can be accomplished relatively quickly and cheaply and complements information collected in other ways.

Aged↗
PubMed1997

Case-control study of GP attendance rates by suicide cases with or without a psychiatric history.

BACKGROUND: Targets for reduction in suicide deaths have been set against a background of an increasing number of people committing suicide. It is often assumed that a reduction can be effected by increasing the detection in primary care of patients at risk. This presupposes that there are indicators that enable suicide risk to be detected reliably. AIM: To compare the characteristics of those who commit suicide with an age- and sex-matched control group in terms of level of general practitioner attendance, diagnosis and pharmacological treatment of mental illness, and to compare those suicides with and without a psychiatric history in terms of general practitioner attendance and history of pharmacological treatment. METHOD: From a total of 48 deaths attributed to suicide and undetermined causes in the Forth Valley in 1993, general practice case notes were located for 41. Live controls were matched to index cases by age, sex and practice. Information on consultations, referrals to secondary care, medication and diagnoses in the previous 10 years was extracted from general practice and, for suicides, psychiatric case notes. RESULTS: Over the 10-year period, suicide patients attended their general practitioner at a higher level than control subjects. However, the number of suicide patients who attended their general practitioner in the month before their death did not differ in comparison with control subjects over a similar period. Suicide cases, in comparison with control subjects, were more likely to have received a psychiatric diagnosis from their general practitioner, been prescribed psychotropic medication and received referral to specialist mental health services. Those suicide patients with a psychiatric history had a significantly higher number of general practitioner consultations than those without a psychiatric history in four out of the five years preceding death. Those suicide patients without a psychiatric history did not differ significantly from control subjects on any of the variables assessed. CONCLUSION: For those people committing suicide who do not have a psychiatric history and whose consultation patterns do not differ from the norm, it is difficult to suggest how general practitioners might improve their detection of relevant suicidal risk factors. For those patients with a psychiatric history who commit suicide, until we have more detailed information regarding the specific content of general practitioner's consultations before death and how these differed from other consultations of the deceased, then it is premature to assume that general practitioners are failing to identify indicators of impending suicide.

Adult↗
PubMed1996

Nursing attitudes to the care of elderly patients at risk of continuing hospital care.

This study assesses changes in nurses' attitudes to the process of decision-making regarding the care of elderly patients identified as being at risk of continuing (long-term) hospital care. It was undertaken during the course of an evaluation of an intervention programme which involved a new approach to decision-making concerning the long-term care of dependent elderly patients. Complementary components of the intervention programme were: (a) an early discharge planning service; and (b) an extended home care programme. The programme involved close liaison of specially trained community health nurses with staff members of the general medical wards of a large general hospital. At the onset of the evaluation, it was perceived by management that the staff of the general medical wards favoured continuing hospital care for very dependent elderly patients rather than community care. It was hypothesized that the intervention programme would result in a change in ward staffs' attitudes concerning the feasibility of home-based care and how decisions about care should be made. To test this, attitude changes of community health nurses and ward nurses were assessed over the period of implementation of the programme. Following the introduction of the programme, the study found that some of the ward nurses' attitudes became closer to those of community health nurses. There was a shift in ward nurses' attitudes away from a professional approach to decisions about the care and placement of very dependent elderly patients to a 'patient choice' approach. Nurses felt more strongly that they had an important role in patient care. Implications of the research are considered in relation to the process of discharge planning.

Aged↗
PubMed1995

Neutrophil activation in paediatric extracorporeal circuits: effect of circulation and temperature variation.

OBJECTIVE: Upregulation of neutrophil adhesion molecules (CD11b and L-selectin) and release of a modulating cytokine (IL8) have been reported in vivo and in vitro in adult cardiopulmonary bypass. The aim of this study was to determine whether paediatric bypass preparations have similar influences and whether neutrophil-endothelium interactions are required for IL8 release. METHODS: In vitro paediatric cardiopulmonary bypass circuits (n = 15) were constructed (identical to those used clinically), as well as static loops (n = 15) using donor blood. The effects of circulation and temperature (17 degrees C, 25 degrees C, 37 degrees C) on the initiation of acute inflammation were examined. Cellular expressions of neutrophil adhesion molecules CD11b and L-selectin were assayed by immunofluorescence technique, and serum IL8, IL6, TNF-alpha, leucocyte elastase, and terminal complement complex were measured by ELISA. RESULTS: In all experiments, an immediate increase in CD11b expression occurred [median values, in relative fluorescence units: 64.9 (range 45.3-212.9) at rest; 365.2 (205-835.4) at 10 min; P < 0.001], along with a decrease in L-selectin expression [153.5 (115.5-220.7) at rest; 42 (12-134) at 10 min; P < 0.01]. Serum concentrations of the following increased gradually and were higher in circulation than in static loops: IL8 [1500 (500-2500) pg.ml-1 in circuit v 600 (180-1500) pg.ml-1 in loop, P < 0.001]; TNF-alpha P < 0.05]; and terminal complement complex [25.9 (6.8-120) v 4.7 (0-21.6) AU.ml-1, P < 0.01]. Cooling decreased and rewarming increased upregulation of CD11b and downregulation of L-selectin and release of IL8. IL6 was undetectable. CONCLUSIONS: In the absence of endothelium, in vitro paediatric cardiopulmonary bypass causes profound acute inflammatory changes in donor blood with release of IL8. These changes were greater than in adult cardiopulmonary bypass. Temperature variation and circulation modulate the responses.

Adult↗
PubMed1995

Monitoring the uptake of Hib vaccine in Forth Valley.

Haemophilus influenzae type b (Hib) infection is an important cause of morbidity and mortality among young children in this country. Immunisation against the disease using protein conjugate Hib vaccine was introduced in the United Kingdom on 1 October 1992. To monitor the impact of this new vaccine in the routine childhood immunisation schedule in Forth Valley Health Board area, a survey of the parents of 200 children born during August 1992 was carried out. A total of 163 (82%) parents responded. While most parents had heard of Hib vaccine or of diseases caused by Hib, specific gaps in their knowledge were noted. In particular a substantial minority (31%) were not aware of the role of Hib vaccine in preventing meningitis. Among health professionals who advised parents on immunisation, the most important group identified by parents were health visitors, followed by family doctors. Leaflets produced by the Health Education Board for Scotland also formed an important and valuable source of information for parents, as did television, radio and newspapers. Monitoring the uptake of Hib vaccine in the sample of 200 children revealed a high uptake of the three recommended doses (96%), with only one child receiving no immunisations at all. If this level of uptake is achieved in other areas then the full potential of the new Hib vaccine in preventing infection among young children will be considerable.

Child, Preschool↗
PubMed1994

Confronting patriarchal attitudes in the fight for professional recognition.

Contemporary nursing practice and education belong to a dynamic process which is likely to change the structure of nursing, as well as the relationships that have been established with other professions. This paper is concerned with the professionalization of nursing and examines how nurses and doctors maintain, or challenge, patriarchal relationships in a clinical context. It also examines the wider social climate which upholds the subordination of women in the caring environment. The implementation of alternative therapies, emphasis on patient education, rehabilitation and individualized care all contribute to a climate in which nurses are able to develop an area that can be deemed as their own. Furthermore, the achievement of research-based practice, and the implementation of primary nursing in many areas, indicate a collective approach to patient care. By linking these developments with a feminist discourse nurses are able to challenge their position within the sexual division of labour and highlight the ambiguous position they occupy.

Attitude of Health Personnel↗
PubMed1993

Measles outbreak in Fife: which MMR policy?

The introduction of measles, mumps and rubella vaccine (MMR) into the United Kingdom childhood immunisation schedule has resulted in a substantial reduction in the incidence of all three diseases. None the less, there have recently been outbreaks of measles in parts of the country which have a record of high MMR uptake among young children. In these outbreaks it is mainly older children who have been affected. This report documents such an outbreak in Fife, an area with a very high MMR uptake among two-year-old children (96%). The current policy of giving MMR vaccine only once to children at 15 months of age may not be sufficient to enable the United Kingdom to achieve the WHO target of measles elimination by the year 2000. Other possible strategies to achieve this objective are discussed.

Adolescent↗
PubMed1993

Car occupant restraint use in Fife: an observational study.

Today road traffic accidents pose a major public health problem with a significant number of deaths and injuries among drivers and passengers of all ages. As part of road safety strategy in Fife the Health Board and Regional Council have carried out an observational study of 7,885 occupants in 4,292 cars to determine the extent of appropriate restraint use in the region. Overall restraint use for urban and non-urban sites was found to be 80%. In car drivers restraint use was 94%. Passengers in all rear seat positions were observed to have a significantly lower level of restraint use, 33% overall compared with 92% overall in the front (chi 2 2,827.9, P << 0.001), with usage of restraint declining with increasing age. Particular problems noted were: the much lower use of restraint among children travelling to and from school, the use of restraint inappropriate to children's age, and the significantly lower level of restraint among taxi drivers and their passengers compared with other cars (chi 2 114.9, P << 0.001). These findings have implications for the promotion of restraint use for all car occupants.

Accidents, Traffic↗
PubMed1993

Automated percutaneous lumbar discectomy versus chemonucleolysis in the treatment of sciatica. A randomized multicenter trial.

A randomized clinical trial was conducted to compare the results of automated percutaneous discectomy with those of chemonucleolysis in 141 patients with sciatica caused by a disk herniation; 69 underwent automated percutaneous discectomy and 72 were subjected to chemonucleolysis. The principle outcome was the overall assessment of the patient 6 months after treatment. Treatment was considered to be successful by 61% of the patients in the chemonucleolysis group compared with 44% in the automated percutaneous discectomy group. At 1-year follow-up, overall success rates were 66% in the chemonucleolysis group and 37% in the automated percutaneous group. Within 6 months of treatment, 7% of the patients in the chemonucleolysis group and 33% in the discectomy group underwent subsequent open surgery. The complication rates of both treatment groups were low, with the exception of a high rate of low-back pain in the chemonucleolysis group (42%). The results of this trial confirm previous controlled studies on chemonucleolysis and suggest that controlled studies should be carried out before automated percutaneous discectomy can be considered a useful intervention.

Adult↗
PubMed1993

Rational use of measles, mumps and rubella (MMR) vaccine.

Measles, mumps, rubella (MMR) vaccine is a live vaccine preparation containing attenuated strains of all 3 viruses. MMR vaccine is widely used throughout the world, with the US having the widest experience with the vaccine. In countries where the vaccine has been introduced successfully, significant reductions in all 3 diseases for which it is protective have occurred. The vaccine has been shown to be highly immunogenic, with seroconversion rates of 95 to 100% being achieved for each of the 3 component vaccines. This immunity appears to be long-lasting and may even be lifelong. Minor adverse effects may occur approximately 1 week after immunisation. Rarely, mumps vaccine-induced meningitis (milder than that associated with wild mumps virus) may occur, its frequency varying with the strain of attenuated mumps virus contained in any particular vaccine. Clinically, the vaccine is indicated for infants aged between 12 and 15 months, and should be administered by intramuscular or deep subcutaneous injection. A few specific contraindications exist, including a genuine hypersensitivity to eggs, and to the aminoglycoside antibiotics kanamycin and neomycin. An increasing number of countries are now adopting a 2-stage MMR policy in an attempt to prevent epidemics among those who remain unprotected, and to move towards eventual disease eradication.

Drug Combinations↗