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Biomedical subjects

I K Crombie

Publications and source records attributed to I K Crombie.

At least 73 records · Page 4Linked to original sources
PubMed1991

Audit of outpatients: entering the loop.

OBJECTIVE: To develop and test a method for routine data collection to observe current practice in outpatient pain clinics. DESIGN: Prospective questionnaire survey completed by consultants on each patient seen during October 1989 to May 1990. SETTING: Outpatient pain clinics of five teaching and five district general hospitals in Scotland and northern England. MAIN OUTCOME MEASURES: Number of new referrals and their source, and characteristics of pain at presentation. RESULTS: 4354 forms were completed by 21 consultants over 29 weeks, corresponding to 2241 patients, of whom 981 were new referrals. The proportion of consultations at which new referrals were seen varied among the 10 clinics from 15% to 34%. The difference could not be accounted for by type of hospital. Sources of new referrals varied widely between the clinics (for example, range 22% to 78% for general practitioner referrals), as did new referrals by the type of pain (range 10.8% to 55.2% for low back pain, 10.5% to 32.5% for pain associated with surgery). However, these differences in types of patients seen could not be accounted for by variations in referral patterns among clinics. Problems identified in performing an audit of outpatients included the difficulty of obtaining firm diagnoses, the need for a method to link successive patient contacts, and the complexity of the presenting problem in many patients. CONCLUSIONS: It is possible to collect data for audit routinely in outpatient clinics. Observation of current practice in the clinics suggested possible unmet need or inappropriate management, which may require changes in practice.

England↗
PubMed1991

Cigarette smoking and employment status.

The smoking habits and health knowledge of the unemployed and the full-time workers were investigated in a cross-sectional study of over 10,000 men and women throughout Scotland. For both sexes (age range 40-59 years), the proportion of current smokers and ever smokers was found to be considerably higher among the unemployed. Only a small part of the difference could be explained by standardisation for social class. The unemployed smokers had began to smoke at an earlier age, with significantly more smoking whilst still at school. Amongst current smokers, the unemployed males reported smoking fewer cigarettes a day, whereas unemployed women smoked more than their full-time counterparts. The reported levels were confirmed by the biochemical measures of smoking; serum thiocyanate and expired air carbon monoxide levels. In contrast to their differences in smoking habit, the two groups were very similar in their knowledge of the hazards of smoking. Smoking habits among the unemployed reflect a complex interaction of financial and both current and previous social factors. Such relationships present a particular challenge to health promotion campaigns.

Adult↗
PubMed1991

Cigarette tar content and symptoms of chronic bronchitis: results of the Scottish Heart Health Study.

STUDY OBJECTIVE: The aim was to determine if there was a relationship between cigarette tar yield and rates of chronic cough and chronic phlegm. SETTING: 22 districts across Scotland were used for the Scottish Heart Health Study (SHHS) which was conducted between 1984 and 1986 and from which the data for this analysis were obtained. SUBJECTS: 10,359 men and women aged 40-59 years were studied. Of these, 2801 current cigarette smokers whose brand of cigarette smoked was known were selected. MEASUREMENTS AND MAIN RESULTS: Data on self reported smoking habits and prevalence of chronic cough and chronic phlegm were obtained from the SHHS. Tar yield was divided into three groups: low (less than or equal to 12 mg/cigarette); middle (13-14 mg/cigarette); high (greater than or equal to 15 mg/cigarette). The average tar yield consumed per person was 13.2 mg/cigarette. Women in the middle and high tar groups had smoked for longer and had significantly higher breath carbon monoxide levels, serum thiocyanate levels, serum cotinine levels, and daily cigarette consumption than the women in the low tar group. This pattern was not seen in men for any of these five smoking variables. Rates of chronic cough and chronic phlegm were higher with higher tar yield of cigarettes smoked for women (low tar v high tar: p less than 0.001) but not for men. Daily cigarette consumption and the number of years of smoking were the most significant risk factors for chronic cough and chronic phlegm for both men and women. Tar was still a significant risk factor (p less than 0.05) for women after controlling for these two risk factors and social class. CONCLUSIONS: Both sexes show strong effects of daily cigarette consumption and years of smoking on respiratory symptoms; women show an additional effect of cigarette tar content while men do not. The spread of tar yield in both sexes was small but there were more women on low tar cigarettes and this may have enabled a weak effect of tar to be seen better in them. On the other hand, tar level in women was confounded with other factors. Statistical methods of controlling for this may not have removed this confounding completely.

Adult↗
PubMed1991

The impact of quitting smoking on symptoms of chronic bronchitis: results of the Scottish Heart Health Study.

Scotland has high rates of death from diseases of the respiratory system and high rates of smoking, especially among women. Data on self reported smoking and prevalence of chronic cough and chronic phlegm among 10,359 men and women aged 40-59 years were obtained from the Scottish Heart Health Study. Overall, current cigarette smokers had rates of chronic cough and chronic phlegm four to five times those of never smokers after standardisation for age (32.3% v 6.5% for men and 24% v 5.5% for women for chronic cough; 31% v 8.3% for men and 21% v 5.5% for women for chronic phlegm). Ex-smokers' symptom rates were a little above those of never smokers and were significant for chronic cough among women and chronic phlegm among men. Men had higher symptom rates than women and this was true for smokers, ex-smokers, and never smokers. The higher rates among men could not be explained by higher cotinine concentrations. Tests to detect "deceivers" among ex-smokers and never smokers using biochemical validation suggested that 87 (1.5%) respondents were in fact smoking; they were excluded from analyses. There were substantially lower rates of chronic cough and chronic phlegm within a year of stopping smoking, and two to four years after stopping 89-99% of the difference between current smokers and never smokers was accounted for (99% and 93% for men and women with chronic cough, 96% and 89% for men and women with chronic phlegm). Even 10 years after stopping, rates of symptoms among ex-smokers remained a little above those of never smokers (except for women with chronic phlegm), though these differences were not statistically significant. Former heavy smokers continued to have rates of chronic cough and chronic phlegm that were higher than those of former light and moderate smokers (though not significantly so). These are cross sectional data, but they emphasise the importance for chronic bronchitis symptoms of giving up cigarette smoking, though the amount previously smoked continues to exert a small influence.

Adult↗
PubMed1991

Controlled comparison of day-patient and out-patient treatment for persistent anxiety and depression.

The effectiveness of day care versus out-patient care in the treatment of persistent severe anxiety and depression was compared in a controlled clinical trial. Of 96 consecutively referred patients meeting the entry criteria, 92 were followed up for six months. Patients were randomised to day care or out-patient care, and assessed at entry and at six months using the Standardised Psychiatric Interview and in terms of their time structuring and socialisation. Marked improvement in all three measures was seen for most of the day patients, but for few of the out-patients: this difference was highly significant for each measure. Day patients also rated themselves as coping more effectively and as more satisfied with their treatment. These differences could not be explained by differences in use of medication. Day treatment should remain an option for patients with persistent anxiety and depression resistant to outpatient treatment.

Activities of Daily Living↗
PubMed1991

A double-blind placebo-controlled trial of theophylline in general practice.

Patients with moderate to severe asthma, from two urban general practices, entered a double-blind randomised placebo-controlled crossover trial of sustained-release theophylline versus placebo. Theophylline was given in therapeutic dosage (to ensure serum levels of between 10 and 20 micrograms/ml) for two months, followed by two months of placebo or vice versa. The results from the 24 patients who entered both theophylline and placebo treatment arms were compared, using outcome measures relevant to general practice care. Theophylline is shown to be of value in the management of asthma in general practice.

Adult↗
PubMed1990

Control of blood pressure in Scotland: the rule of halves.

OBJECTIVE: Audit of detection, treatment, and control of hypertension in adults in Scotland. DESIGN: Cross sectional survey with random population sampling. SETTING: General practice centres in 22 Scottish districts. SUBJECTS: 5123 Men and 5236 women aged 40-59 in the Scottish heart health study, randomly selected from 22 districts throughout Scotland, of whom 1262 men and 1061 women had hypertension (defined as receiving antihypertensive treatment or with blood pressure above defined cut off points). MAIN OUTCOME MEASURE: Hypertension (assessed by standardised recording, questionnaire on diagnosis, and antihypertensive drug treatment) according to criteria of the World Health Organisation (receiving antihypertensive treatment or blood pressure greater than or equal to 160/95 mm Hg, or both) and to modified criteria of the British Hypertension Society. RESULTS: In half the men with blood pressure greater than or equal to 160/95 mm Hg hypertension was undetected (670/1262, 53%), in half of those in whom it had been detected it was untreated (250/592, 42%), and in half of those receiving treatment it was not controlled (172/342, 50%). In women the numbers were: 486/1061, 46%; 188/575, 33%; and 155/387, 40% respectively. Assessment of blood pressure according to the British Hypertension Society's recommendations showed an improvement, but in only a quarter of men and 42% of women was hypertension detected and treated satisfactorily (142/561, 215/514 respectively). IMPLICATIONS: The detection and control of hypertension in Scotland is unsatisfactory, affecting management of this and other conditions, such as high blood cholesterol concentration, whose measurement is opportunistic and selective and depends on recognition of other risk factors.

Adult↗
PubMed1990

Effect of vitamin and mineral supplementation on verbal and non-verbal reasoning of schoolchildren.

In a randomised controlled trial the effect of vitamin and mineral supplementation for seven months on performance in tests of reasoning was studied in 86 schoolchildren aged 11-13. A small, non-significant difference between the control and supplementation groups was found in a non-verbal test. The net difference in change in scores between the active and placebo groups was 2.4 units (95% CI-1.5 to 6.3). This direction of effect was not consistently seen with three other tests of non-verbal reasoning. Vitamin and mineral supplementation does not improve the performance of schoolchildren in tests of reasoning.

Administration, Oral↗
PubMed1990

Cardiovascular disease in Edinburgh and north Glasgow--a tale of two cities.

Scotland has one of the highest mortality rates from coronary heart disease for both men and women. However within Scotland there are major geographical differences in the mortality rates, exemplified by the differences between the two largest Scottish cities. Glasgow on the west has a much higher mortality rate for cardiovascular diseases than Edinburgh in the east. During 1986 coronary risk factor population surveys were conducted simultaneously in Edinburgh and North Glasgow as part of the WHO MONICA study. These surveys employed standardized methods and the central quality control of the WHO project. Measures of coronary heart disease morbidity were higher in North Glasgow, except for electrocardiographic evidence of ischaemia, consistent with the mortality rates. The major coronary risk factors were uniformly higher in North Glasgow than in Edinburgh, except for serum lipids which were not significantly different. The risk factors, except the lipids, showed a gradient by socioeconomic status, so that when the risk factors levels were standardized for housing tenure the significant differences between the cities largely disappeared, and the serum cholesterol levels in women become significantly higher in Edinburgh because of their slight negative relationship with social status. This study shows that the socioeconomic differences between Edinburgh and North Glasgow largely explain the coronary risk factor differences between the cities. The socioeconomic differences in coronary disease and its major risk factors require further investigation and may be more fundamentally important than the geographical differences in the patterns of coronary heart disease.

Adult↗
PubMed1990

Can changes in the unemployment rates explain the recent changes in suicide rates in developed countries?

Data were collected on unemployment and suicide rates in 16 developed countries for 1973 and 1983 (suicide rates were three-year averages). Unemployment rates rose appreciably in men and women in all countries. Among men suicide rates rose in 14 of the countries whereas among women they did so in only seven. A mathematical model was developed to investigate, for those countries with increased suicide rates, how much of the increase could be contributed by an increase in the numbers unemployed. It was found that the proportion of the increase that could be 'explained' varied considerably between countries. In general the amount of the increase explained was small, and often a considerable increase in the suicide rates among those employed would be required to account for the observed increase in the suicide in the whole population. It is concluded that unemployment shows an inconsistent relationship with suicide. Further, if a relationship does exist in some countries the effect may be as much a generalized one on the whole population as a specific effect on the unemployed. Finally the possible effects of unemployment on suicide differ appreciably between men and women.

Adolescent↗
PubMed1990

Alcohol consumption and unemployment among men: the Scottish Heart Health Study.

There is growing concern about the relationship between health-related behaviour and employment status. Data from the Scottish Heart Health Study included information on the self-reported drinking habits of 4170 full-time employed and 479 unemployed men. This enabled the patterns of alcohol consumption in the unemployed to be compared to those of the full-time workers. There were appreciable differences in both frequency and quantity of reported alcohol consumption between the two groups and a higher percentage of the unemployed reported being non-drinkers. Nevertheless, the unemployed drinkers drank more alcohol than those in employment, even after standardization for both age and social class (27.9 units vs 20.7 units per week). Binge drinking was common in both groups, but the proportion was higher among the unemployed (58.8% of the unemployed reported drinking more than eight units in any day in the previous week compared to 33.5% among the full-time workers). In an attempt to validate these findings and to assess the possible health consequences of heavy drinking, serum gamma-glutamyltransferase levels were analysed. Overall, the unemployed were found to have higher levels, this finding being largely influenced by the excess of heavy drinkers. The reasons behind these differences in drinking behaviour between the employed and unemployed need to be identified before any cause and effect hypotheses can be generated, and counselling given where needed.

Adult↗
PubMed1990

Geographical clustering of risk factors and lifestyle for coronary heart disease in the Scottish Heart Health Study.

A large cross sectional study, the Scottish Heart Health Study, of 10,359 men and women from 22 districts of Scotland was undertaken to try to explain the geographical variation of coronary heart disease mortality. Analysis by district showed that of the classic risk factors only cigarette smoking was strongly associated with heart disease mortality among both men and women. Mean diastolic blood pressure was weakly associated with rates among men and high density lipoprotein cholesterol showed a strong negative association among women. Total cholesterol showed a weak negative association with heart disease mortality, but, because the serum concentrations of cholesterol were uniformly high in all districts, a strong association with mortality would not be expected. In both men and women many dietary factors showed moderate or strong associations with mortality from coronary heart disease in a district--of these a low consumption of vitamin C was most notable. Other factors associated with heart disease included alcohol consumption and serum triglycerides among men, and obesity, physical activity, and serum triglycerides among women. Many factors associated with heart disease showed strong intercorrelations. Clustering of risk factors (including smoking, alcohol, and diet among men, and smoking, diet, and obesity among women) was associated with much of the regional variation in heart disease mortality in Scotland.

Adult↗
PubMed1990

Prevalence of coronary heart disease in Scotland: Scottish Heart Health Study.

Data from 10,359 men and women aged 40-59 years from 22 districts in the Scottish Heart Health Study were used to describe the prevalence rates of coronary heart disease in Scotland in 1984-1986 and their relation to the geographical variation in mortality in these districts. Prevalence was measured by previous history, Rose chest pain questionnaire, and the Minnesota code of a 12 lead resting electrocardiogram. The prevalence of coronary heart disease in Scotland was high compared with studies from other countries that used the same standardised methods. A history of angina was more common in men (5.5%) than in women (3.9%), though in response to the Rose questionnaire 8.5% of women and 6.3% of men reported chest pain. A history of myocardial infarction was three times more common in men than women, as was a Q/QS pattern on the electrocardiogram. There were significant correlations between the different measures of coronary prevalence. District measures of angina correlated well with mortality from coronary heart disease, and these correlations tended to be stronger in women than in men. There was no significant correlation between mortality from coronary heart disease and measures of myocardial infarction. The study provides data on the prevalence of coronary heart disease in men and women that are valuable for the planning of cardiological services.

Adult↗