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Biomedical subjects

J E Ward

Publications and source records attributed to J E Ward.

At least 37 records · Page 2Linked to original sources
PubMed2000

An analysis of resources for indigenous women in NSW about cervical screening.

OBJECTIVE: To examine resources about cervical screening made available to Indigenous women in NSW. METHOD: An Aboriginal woman, on behalf of another Aboriginal woman, telephoned 47 NSW based organisations in May 1998 for information about cervical screening. Received materials were analysed for format, content and readability and then submitted to a panel of Indigenous women for their feedback. RESULTS: Of those 34 organisations agreeing to send resources, only 20 (59%) did so. After removing duplicates, 12 cervical screening resources were available for review of which six were designed and printed in NSW and the other six originated outside NSW. Of the six resources developed in NSW, two (33%) were for Aboriginal women. Of the six resources originating from outside of NSW, another two (33%) also were for Aboriginal women. The Flesch readability scores for resources ranged from 58.6 to 87.27. Those developed in NSW had a significantly lower readability score than those from outside of NSW (p = 0.025). Despite lower education levels among the target group, there was no difference in the readability scores of resources designed for Indigenous women (p = 1). CONCLUSIONS: Most resources obtained by us were not tailored for Indigenous women. IMPLICATIONS: This study has set a base line for resources available for Indigenous women. Our method could be replicated in the future to evaluate and monitor improvement.

Adolescent↗
PubMed2000

Smoking among ethnic Chinese patients and their recall of quit advice by Chinese-speaking general practitioners in Sydney.

OBJECTIVES: To collect smoking-related data from Chinese patients attending Chinese-speaking general practitioners (CSGPs), including self-reported smoking status, recall of a question about smoking status during the previous six months by their GP and, for smokers, their recall of quit advice in their most recent consultation. DESIGN: Descriptive research first involving self-administered waiting-room questionnaires and, afterwards, a second self-administered questionnaire to examine behaviour in that most recent consultation. SETTING: Surgeries of 24 CSGPs in Central Sydney. SUBJECTS: 1084 Chinese patients aged 18-70 years. RESULTS: Self-reported smoking prevalence was 25% (95% CI: 21%-29%) for men and 4% (95% CI: 2%-5%) for women. Of 103 smokers who had visited their regular GP during the previous 6 months, 42% recalled a question about smoking status and 38% quit advice. As elicited at follow-up, 72% recalled any discussion in their most recent consultation about smoking although effective techniques were rarely recalled. Patient's sex (OR: 1.78; 95% CI: 1.28-2.47) and smoking status (OR: 1.39; 2.38; 95% CI: 0.85-2.25, 1.49-3.81) independently predicted a question about smoking status. Among smokers, marital status was the only independent predictor of quit advice. As assessed by a stage-of-change scale, significantly more Chinese smokers were not ready to contemplate cessation, compared with Angio-Celtic community survey results. CONCLUSIONS: Our study provides unique information about smoking among ethnic Chinese patients attending CSGPs. Findings also suggest CSGPs need greater support to maximize their clinical opportunities to advise Chinese smokers to quit.

Adult↗
PubMed2000

Validation of women's self-reported smoking status in a Sydney colposcopy clinic.

This study validated a self-reported smoking prevalence questionnaire against urinary cotinine levels among women referred to a Sydney based public hospital colposcopy clinic over the period November 1997 to June 1998. Of 213 eligible women, 160 (75%) agreed to participate. Of these, 151 (94%) completed the smoking prevalence item and 130 (86%) also provided a urine specimen. 40% (95% CI: 33%-49%) of respondents self-reported as current smokers. Observed agreement between self-reported and biochemically validated smoking status was 94% compared with 52% chance agreement (kappa = 0.87, p<0.001). This high level of agreement was also robust to sensitivity analyses using a more conservative cutoff for the urinary cotinine levels. We conclude that self-reported smoking status provides valid estimates of actual rates of smoking among women referred with abnormal cervical smears.

Adolescent↗
PubMed2000

Community study of uncomplicated lower urinary tract symptoms among male Italien immigrants in Sydney, Australia.

OBJECTIVE: To determine the prevalence, levels of bother and self-reported management of lower urinary tract symptoms (LUTS) in Italian-born men aged 40-80 years. METHOD: 305 randomly selected men aged 40-80 years (72% response rate) participated in a community-based study (computer-assisted telephone survey) in early 1997 in Sydney, Australia. RESULTS: LUTS are common: 41% of men needed to wake up at least once at night to urinate; 35% indicated they had terminal dribbling 'sometimes' or 'frequently'; 31% experienced urgency although few (3%) had urge incontinence; 19% could retain urine in their bladder during the day for no more than 2 h, and 19% experienced hesitancy. Urinary symptoms correlated moderately/poorly with self-rated bother. The prevalence of bothersome frequency and urgency was significantly age-related. Only half (n = 49, 52%) of the men bothered by urinary symptoms had seen a general practitioner (GP) about these symptoms in the last 5 years: of these three quarters had been referred to a urologist and half of these had received surgical treatment. Anxiety about prostate cancer, but not the degree of bother from urinary symptoms, independently predicted attendance at a GP (adjusted odds ratio 6.4, p = 0.006). CONCLUSIONS: Although LUTS are common in Italian-born men, their experiences of bother do not correlate well with symptoms and do not appear to influence referral and treatment. Education is needed to improve men's understanding of the importance of 'bother' as an indicator for urological surgery.

Adult↗
PubMed2000

Particle transport in the zebra mussel, Dreissena polymorpha (Pallas).

The capture, transport, and sorting of particles by the gills and labial palps of the freshwater mussel Dreissena polymorpha were examined by endoscopy and video image analysis. More specifically, the morphology of the feeding organs in living zebra mussels was described; the mode and speeds of particle transport on the feeding organs was measured; and the sites of particle selection in the pallial cavity were identified. Particle velocities (outer demibranch lamellae, 90 microm s(-1); inner demibranch lamellae, 129 microm s(-1); marginal food groove of inner demibranchs, 156 microm s(-1); dorsal ciliated tracts, 152 microm s(-1)), as well as the movement of particles on the ctenidia and labial palps of D. polymorpha, are consistent with mucociliary, rather than hydrodynamic, transport. Particles can be sorted on the ctenidia of zebra mussels, resulting in a two-layer transport at the marginal food groove of the inner demibranch. That is: preferred particles are transported inside the marginal groove proper, whereas particles destined for rejection are carried superficially in a string of mucus. Sorting also occurs at the ventral margin of the outer demibranch; desirable particles are retained on the outer demibranch, whereas unacceptable particles are transferred to the inner demibranch and ultimately excluded from ingestion. We suggest that the structure of homorhabdic ctenidia does not preclude particle sorting, and that some ecosystem modifications attributed to zebra mussels may ultimately be due to ctenidial sorting mechanisms.

Animals↗
PubMed1999

General practitioners' perceptions of medicolegal risk. Using case scenarios to assess the potential impact of prostate cancer screening guidelines.

OBJECTIVE: To ascertain general practitioners' perceptions of medicolegal risk when screening for prostate cancer, and explore the potential impact of three national guidelines on perceptions and clinical practice. DESIGN: Postal survey in August 1997. PARTICIPANTS: 219 randomly selected GPs in New South Wales (65% response rate). MAIN OUTCOME MEASURES: Response to case scenarios; perceptions of medicolegal risk and protection afforded by national guidelines before and after reading extracts of three national guidelines; ratings of current and potential strategies to increase GPs' sense of medicolegal protection. RESULTS: 90% (95% CI, 86.5%-94.3%) would screen an asymptomatic male patient and 61% (95% CI, 54.2%-67.2%) indicated GPs would be at risk if they did not screen. Although significant changes in responses were found after respondents had read guideline extracts, 46% (95% CI, 39.5%-52.7%) continued to perceive medicolegal risk if screening was not performed. About two-thirds (65%; 95% CI, 59.9%-72.5%) supported a clear statement about the legal status of guidelines in a court of law to increase their sense of medicolegal protection. CONCLUSIONS: Even when made aware of national evidence-based guidelines against prostate cancer screening, GPs in our survey perceived limited hypothetical medicolegal protection.

Adult↗
PubMed1999

General practitioners' attitudes to randomised clinical trials for women with breast cancer.

OBJECTIVE: To determine general practitioners' attitudes to randomised clinical trials for women with breast cancer. DESIGN: Cross-sectional survey with structured face-to-face interviews conducted between December 1997 and May 1998. PARTICIPANTS: A random sample of GPs in central Sydney. MAIN OUTCOME MEASURES: GPs' attitudes to referring women with breast cancer to specialists who enrol patients in randomised clinical trials, and to randomised clinical trials in general. RESULTS: 85 of 158 GPs (54%) consented to be interviewed. Of these 85 GPs, 47% stated that they would refer a woman with breast cancer to a specialist who was likely to enrol the woman in a clinical trial; 50% believed that clinical trials increase knowledge about treatment options; and 15% thought that randomised trials may make a valuable scientific contribution. However, 43% of GPs expressed concerns that their patients may be disadvantaged, 39% said that they wanted optimum treatment for their patients, 18% that they would want to know what the trial was about, and 12% were worried about ethical considerations. CONCLUSIONS: Many of the GPs in this survey have concerns about randomised clinical trials for women with breast cancer. Improved communication between specialists and GPs about the conduct of and treatments offered in clinical trials for breast cancer may change this attitude.

Attitude of Health Personnel↗
PubMed1999

Prostate cancer testing: behaviour, motivation and attitudes among Western Australian men.

OBJECTIVE: To estimate the proportion of Western Australian men aged 40-80 years who had been tested for prostate cancer, their experiences of screening and perception of its benefit. DESIGN AND SETTING: Cross-sectional survey (random telephone survey) of Western Australian men conducted in February 1998. PARTICIPANTS: 400 men aged 40-80 years from 670 eligible households (60% response rate from contactable households with eligible men). MAIN OUTCOME MEASURES: Proportion of respondents tested for prostate cancer (by prostate-specific antigen [PSA] test or digital rectal examination); reasons for having been tested; information provided by the doctor before testing; reasons given for and beliefs about the benefits of testing. RESULTS: Of 391 asymptomatic men, 220 (56%) recalled having been tested for prostate cancer and 167 (43%) had had a PSA test. Of those tested, 86% had their first test in the previous five years. The two most common reasons for testing were media publicity and general practitioner recommendation. Thirty-eight per cent of men tested during the previous five years reported that the doctor did not discuss the "pros and cons" of the test; 39% reported a discussion of less than five minutes' duration; 17% were given printed information before undergoing the test for the first time. Half were "very convinced" of the benefits of testing for prostate cancer. CONCLUSIONS: Men are being tested for prostate cancer with minimal pretest counselling or written information.

Adult↗
PubMed1999

Aboriginal health: why is reconciliation necessary?

Many health professionals are deeply troubled by the persistent health inequities between Aboriginal and non-Aboriginal Australians. From a social and political perspective it is clear that, for there to be appreciable improvement in Aboriginal health, a process of reconciliation which acknowledges the past in the light of the present needs to be adopted across all sectors of society. We give some practical advice for promoting reconciliation.

Australia↗
PubMed1999

Australian general practitioners' views and use of colorectal cancer screening tests.

OBJECTIVES: To determine general practitioners' (GPs) current beliefs, knowledge and self-reported practices of screening for colorectal cancer. DESIGN AND SETTING: Postal survey of national random sample of 1271 GPs in 1996. OUTCOME MEASURES: GP views on effectiveness of faecal occult blood testing (FOBT) and flexible sigmoidoscopy in reducing premature death from colorectal cancer in "average-risk" patients (asymptomatic with no family history); views on frequency of tests and target group; use of these tests; and independent predictors of views and use. RESULTS: Response rate was 67%. FOBT and flexible sigmoidoscopy were said to be effective as screening tests by 38% and 61% of GPs, respectively, but 30% and 25% were unsure. Independent predictors of belief in screening effectiveness were State of practice (for FOBT), male sex and awareness of Gut Foundation guidelines (for flexible sigmoidoscopy) and increasing age (for both). Most often chosen screening frequencies were every year for FOBT (29%), and five-yearly for flexible sigmoidoscopy (24%), although 19% and 26%, respectively, were unsure of the appropriate screening interval. Most often cited target group was people aged over 40 years with first-degree relatives with colorectal cancer: 63% of GPs would offer FOBT and 74%, flexible sigmoidoscopy. Fewer than 3% of GPs were likely to adopt an opportunistic approach to screening, yet 15% would be highly likely to recommend FOBT during a dedicated health check-up for a 58-year-old male patient, and 9% for a female patient. CONCLUSION: The absence to date of a coherent national policy on colorectal cancer screening is associated with wide variations in views and practice that are inconsistent with the available evidence. If GPs are to be involved in implementing population screening, national policy must be widely and effectively promulgated.

Adult↗
PubMed1999

General practitioners' use of evidence databases.

OBJECTIVE: To determine the awareness and use of the Cochrane Library and access to the Internet by general practitioners in New South Wales. DESIGN: Cross-sectional postal survey in September 1997. PARTICIPANTS: 311 of 428 (73% response rate) randomly selected general practitioners in New South Wales. MAIN OUTCOME MEASURES: Proportion of respondents with access to the Internet at home or at work; proportion of respondents aware of, with access to, and ever using the Cochrane Library; independent predictors of awareness of the Cochrane Library. RESULTS: 134 respondents (43%) had access to the Internet either at home or at work; 42 (14%) were "on line" at their workplace. Seventy (22%) were aware of the Cochrane Library, although only 20 (6%) had access to it and 13 (4%) had ever used it. Those in group practice and members of Divisions were independently more likely to be aware of the Cochrane Library. CONCLUSIONS: As patient outcomes will improve with systematic implementation of evidence-based treatments, these low rates of access to useful evidence databases raise issues regarding the best ways to support general practitioners with information technology.

Adult↗
PubMed1999

Skin cancer screening by Australian family physicians: variation with physician beliefs and geographic locality.

INTRODUCTION: Australian national policies do not recommend skin cancer screening. We measured family physicians' beliefs, self-reported practices, and predictors of using clinical skin examination for skin cancer screening. METHOD: Random self-administered postal survey of 1271 Australian family physicians (FPs) performed during 1996, obtaining 855 completed questionnaires (67% response rate). RESULTS: Eighty-six percent of FPs surveyed indicated that they thought clinical skin examination was effective in reducing premature death from skin cancer; 72% indicated that they should be performed annually; and 60% indicated that all adults should be screened. Only 3% indicated correctly that screening has not been tested to determine its effectiveness. Although most FPs were unlikely to adopt an opportunistic approach to screening, 64% indicated that they would recommend clinical skin examination during a health check-up. FPs in northern (high incidence) latitudes were 3 to 4 times more likely to adopt opportunistic screening, and twice as likely to discuss clinical skin examination in a dedicated check-up. FPs were more likely to advocate screening in male rather than female patients. Half of respondents were unaware of relevant guidelines. CONCLUSION: Although Australian policies do not recommend clinical skin examination because of insufficient evidence as yet of effectiveness, FPs show considerable support for screening. Geographic location, patient gender, and physician beliefs predict the self-reported provision of clinical skin examination by family physicians, suggesting that factors other than published guidelines affect clinical practice.

Adult↗
PubMed1999

Strategies to improve cancer screening in general practice: are guidelines the answer?

BACKGROUND: GPs are ideally placed to recommend appropriate cancer screening for their patients. However, opportunities to discuss screening are often missed and screening procedures are not always recommended in accordance with national policy. The development of clinical practice guidelines represents one strategy for improving cancer screening in general practice. OBJECTIVE: We aimed to ascertain Australian GPs' ratings of current clinical practice guidelines and their views of the likely usefulness of 18 strategies to improve cancer screening in general practice. METHOD: A self-administered questionnaire was mailed to a national random sample of 1271 GPs in May 1996. Responders rated the usefulness of each of eight clinical practice guidelines current at the time of the survey. They then rated the usefulness of each of 18 strategies for support of cancer screening. RESULTS: We received 855 completed questionnaires (a 67% response rate). There was greatest support for guidelines already available on breast and cervical cancer. The most popular strategy to improve cancer screening was seminars with experts in preventive care, rated as 'very useful' by 658 (77%), followed by NHMRC guidelines (597, 70%) and pamphlets for patients (587, 69%). There was less support for more innovative strategies including assessment and feedback (35%), case finding by nurse practitioners (11%) and academic detailing (10%). CONCLUSION: Responders indicated that strategies involving passive dissemination of information would be most useful for improving cancer screening in general practice. Identification of an effective combination of acceptable initiatives is needed.

Attitude of Health Personnel↗
PubMed1999

Evaluation of doctors' reminders in emergency departments to encourage cervical screening.

OBJECTIVE: To evaluate opportunistic reminders in emergency departments (EDs) about cervical smears. METHOD: Five EDs in Sydney in 1995-96 participated in a block-randomised control trial, whereby unscreened women at risk for cervical cancer who were seen as nonacute cases were allocated either to brief advice at the end of the ED consultation to return to their GP for a smear (intervention) or usual care (control). Blinded follow-up telephone interviews determined women's compliance four weeks later. RESULTS: 217 women at risk for cervical cancer presented, of whom 53 (23%) were overdue for a Pap smear (22 intervention group; 31 control group). At follow-up, no women in the intervention group had had a smear, although 3 (10%) in the control group had (p = 0.25). CONCLUSIONS: Opportunities in EDs in NSW for opportunistic reminders are infrequent and, even if taken, are unlikely to encourage screening over and above usual care. IMPLICATIONS: General practice remains a more effective location for opportunistic recruitment, although interventions with hospitalised in-patients also show greater promise than reminders in EDs.

Adolescent↗
PubMed1999

Estimates of smoking and related behaviour in an immigrant Lebanese community: does survey method matter?

OBJECTIVE: To estimate the prevalence of smoking, stage-of-change and GP advice to quit in the Sydney Lebanese community and whether these findings varied by survey method. METHOD: Three methods--telephone interviews using sampling from the electronic White Pages, personal interviews of a household member selected using cluster sampling and a mailed survey using an electoral roll sample--were used in separate surveys of persons born in Lebanon living in three postcode areas of Sydney in 1997. RESULTS: Smoking prevalence was consistent across the three methods, with male smoking averaging 49% and female smoking averaging 29%. About two-thirds of smoking respondents across each of the survey methods had no plans for quitting. CONCLUSIONS: As smoking prevalence did not vary across the three sampling and survey methods used here, the simplest and most inexpensive method (the electronic White Pages and telephone surveying of identifiable ethnic surnames) should be preferred. IMPLICATIONS: Smoking prevalence in the Sydney Lebanese community is determined consistently using a variety of survey methods.

Arabs↗
PubMed1999

Population-based cancer control: where is the greatest benefit from proven strategies to 'regain' years of life lost prematurely?

OBJECTIVE: To apply a 'health gain' approach to population-based cancer control. METHOD: We calculated the potential years of life otherwise lost prematurely which could be 'regained' through implementation of cancer control programs for which Level I or Level II evidence already exists for population outcomes. RESULTS: More potential years of life lost (PYLLs) would be 'regained' by enforcing a 'smoke-free' Australia than by any other possible scenario based on proven effectiveness. Even achievable scenarios for tobacco control (17% or 20% prevalence) would 'regain' more PYLL than either mammographic screening according to national policy or faecal occult blood testing (FOBT) of both men and women over 50 years for colorectal cancer. CONCLUSIONS: As few commentators remain optimistic that more money will be allocated to health, strategic thinking for health gain needs to re-appraise resource allocation for population-based cancer control in Australia. IMPLICATIONS: We recommend wider debate in response to our finding that, on the basis of best available evidence, the greatest potential for health gain lies less in cancer screening than fully funded tobacco control.

Aged↗