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J Mant

Publications and source records attributed to J Mant.

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

The London handicap scale: a re-evaluation of its validity using standard scoring and simple summation.

OBJECTIVE: To assess the validity of the London handicap scale (LHS) using a simple unweighted scoring system compared with traditional weighted scoring METHODS: 323 patients admitted to hospital with acute stroke were followed up by interview 6 months after their stroke as part of a trial looking at the impact of a family support organiser. Outcome measures included the six item LHS, the Dartmouth COOP charts, the Frenchay activities index, the Barthel index, and the hospital anxiety and depression scale. Patients' handicap score was calculated both using the standard procedure (with weighting) for the LHS, and using a simple summation procedure without weighting (U-LHS). Construct validity of both LHS and U-LHS was assessed by testing their correlations with the other outcome measures. RESULTS: Cronbach's alpha for the LHS was 0.83. The U-LHS was highly correlated with the LHS (r=0.98). Correlation of U-LHS with the other outcome measures gave very similar results to correlation of LHS with these measures. CONCLUSION: Simple summation scoring of the LHS does not lead to any change in the measurement properties of the instrument compared with standard weighted scoring. Unweighted scores are easier to calculate and interpret, so it is recommended that these are used.

Disability Evaluation↗
PubMed2000

Inter-rater reliability of the Frenchay activities index in patients with stroke and their careers.

OBJECTIVE: To measure the inter-rater reliability of the interview-administered version of the Frenchay Activities Index (FAI). DESIGN: Comparison of FAI score on the same person when administered by two raters (mean time between interviews 15.2 days). SUBJECTS: Fifty-nine Oxfordshire residents who either had had a stroke (n = 35) or were the main carer (n = 24). RESULTS: The 95% limits of agreement for the FAI totals were -9.9 to +8.4. The kappa statistic for nine of the 15 items showed a good level of agreement between the two research interviews (0.64-0.80). The other six items showed fair or moderate strength of agreement (0.26-0.52). Three items showed significant differences between the two raters p < 0.05 (Wilcoxon's sign paired rank sum test). The mean difference between the total scores was -0.76 (95% confidence interval from -1.98 to 0.46). Spearman's rho correlation coefficient for FAI totals of rater B against A was r(59) = 0.93 (p < 0.001). CONCLUSION: The FAI is a reliable tool for measuring outcome following stroke. Suggestions are made to strengthen the reliability, and consequently the validity of the measure.

Activities of Daily Living↗
PubMed1999

Oral contraception and other factors in relation to back disorders in women: findings in a large cohort study.

The Oxford-Family Planning Association contraceptive study includes 17,032 women, initially aged 25-39 years, recruited at 17 British family planning centers during the interval 1968-1974 and subsequently followed-up for periods up to 26 years. This article examines the pattern of referral to hospital for back disorders among these women. Certain back disorders have been reported to occur more frequently in oral contraceptive users than in other women, and back pain has also been reported in some women consequent to using an intrauterine device. The disorders considered were spinal osteoarthritis, displaced cervical disc, displaced lumbar disc, other and unspecified displaced disc, cervicalgia, unspecified back pain, and sprains and strains of the back. Spinal osteoarthritis and unspecified backache were the only two conditions significantly related (both positively) to age. Displaced lumbar disc and other and unspecified displaced disc were strongly positively related to height and weight. Unspecified backache showed similar, but less striking (in terms of the magnitude of the relative risks), associations with height and weight. Little evidence was found of any association between oral contraceptive use and any of the back disorders, and the same was true for intrauterine device use.

Adult↗
PubMed1998

Oral contraception and other factors in relation to hospital referral for fracture. Findings in a large cohort study.

There is good evidence that estrogens and progestogens have an important effect on bone metabolism. This article explores the relationship between oral contraceptive (OC) use and fractures occurring at various sites among the 17,032 participants in the Oxford-Family Planning Association contraceptive study, which now includes information accumulated during 310,000 woman-years of observation between 1968 and 1994. In total, 1308 women suffered at least one fracture during the follow-up period, which was largely confined to premenopausal years. When all fractures were combined, there was a modest, but highly significant trend (p < 0.001) of increasing risk with total duration of oral contraceptive use. In addition, there was statistically significant heterogeneity (p < 0.01) when overall fracture rates were examined in relation to recency of oral contraceptive use during the premenopausal lifespan. The highest relative risk (1.3, 95% CI 1.1-1.5) was for current or recent oral contraceptive users; however, viewed as a whole, no clear pattern of risk was apparent. Examination of the data for individual fracture sites (including the lower end of the radius/ulna) did not provide any evidence of a protective effect of oral contraceptive use. These results are closely similar to those reported from the Royal College of General Practitioners Oral Contraception Study in 1993.

Adult↗
PubMed1998

Risk of myocardial infarction, angina and stroke in users of oral contraceptives: an updated analysis of a cohort study.

OBJECTIVES: To investigate risk of myocardial infarction, angina and stroke in users of contraceptive pills compared with users of other methods of contraception. DESIGN: Prospective cohort study, with recruitment between 1968 and 1974 and annual follow up until the age of 45 years. After this age, only women who had never used oral contraception or those who had used it for eight or more years continued to be followed up annually until July 1994. SETTING: Seventeen family planning clinics in England and Scotland. POPULATION: 17,032 women aged between 25 and 39 years at entry to the study. MAIN OUTCOME MEASURES: Occurrence of angina, myocardial infarction or stroke that was associated with either hospital admission or outpatient referral to hospital or death. RESULTS: Increased risk of myocardial infarction in oral contraceptive users was observed only in women who were heavy smokers at entry to the study. In this subgroup the relative risk of a myocardial infarction was 4.2 (95% CI 1.4-16.6) in ever users of oral contraception compared with non-users, 4.9 (1.2-23.6) in current users, and 4.0 (1.3-16.2) in ex-users. In all current users the relative risk of angina was 0.5 (0.1-1.4), and the relative risk of ischaemic stroke was 2.9 (1.3-6.7). The increased risk of ischaemic stroke did not persist in ex-users. CONCLUSIONS: Use of oral contraception is associated with increased risk of ischaemic stroke and increased risk of myocardial infarction (only in heavy smokers), but no increased risk of angina. These increased risks need to be considered within the context of the very low absolute risks of cardiovascular disease in this population. 5880 women need to take oral contraception for one year to cause one extra stroke, and 1060 women who are heavy smokers need to take it for one year to cause one extra myocardial infarction.

Adult↗
PubMed1998

The impact of an information pack on patients with stroke and their carers: a randomized controlled trial.

OBJECTIVES: To assess the impact of information packs on patients with stroke and their carers, and to pilot some of the methodology for a trial of a Family Support Organiser (FSO). SUBJECTS: Seventy-one patients admitted to Oxford hospitals with acute stroke during February-July 1995, and 49 informal carers of these patients. DESIGN: Randomized controlled trial. Intervention group received an Information pack containing various Stroke Association publications one month after their stroke, or at discharge from hospital, whichever was sooner. Control group received nothing. Follow-up was by interview at the place of residence of the patients six months after their stroke. MEASURES: Outcome measures assessed knowledge about stroke; satisfaction with information received; patient behaviour in terms of access to community services and benefits; and health status and quality of life. RESULTS: Patients and carers in the intervention group tended to know more about stroke, but these differences were not significant once adjusted for age. Patients in the intervention group (but not carers) tended to be more satisfied with the information that they had received, but the differences were not significant. There were no differences with regard to any aspects of quality of life in patients in the intervention group, though carers in the intervention group were found to have significantly better mental health (p = 0.04). CONCLUSIONS: While the study was too small to generate firm conclusions, information leaflets may lead to improved knowledge about stroke several months after they have been distributed. This finding is worth following up with larger studies. The stroke knowledge questionnaire that was piloted in this trial seems to be able to detect differences between groups.

Aged↗
PubMed1997

Combined oral contraceptives and liver disease.

Although some information is available about the risk of liver tumors associated with combined oral contraceptive use, little is known about the relationship with other hepatic problems. Data from two large long-term observational studies, the Royal College of General Practitioners (RCGP) Oral Contraception Study and the Oxford-Family Planning Association (Oxford-FPA) Study, were used to examine this issue. Observations accumulated over a period of up to 27 years were available for each study. The incidence of liver disease in each study was low. There was no evidence of an increased risk of serious liver disease overall among current or former pill users. The RCGP study found a modest increased risk of mild liver disease associated with oral contraceptive use which declined after four years of use and after cessation of use. This increased risk occurred in women who had used oral contraceptives containing more than 50 micrograms of estrogen.

Adult↗
PubMed1997

Epidemiology of genital prolapse: observations from the Oxford Family Planning Association Study.

OBJECTIVE: To explore the epidemiology of uterovaginal and post-hysterectomy prolapse. DESIGN: Cohort study. SETTING: Seventeen large family planning clinics in England and Scotland. POPULATION: 17,032 women who attended family planning clinics between 1968 and 1974, aged between 25 and 39 years at study entry. METHODS: Annual follow up by interview, postal or telephone questionnaire until July 1994. Further details on all hospital admissions were obtained from the hospital discharge summaries. All women were flagged at time of recruitment in the NHS central registers. MAIN OUTCOME MEASURE: In-patient admission with diagnosis of prolapse (ICD codes 8th Revision 623.0-623-9). RESULTS: The incidence of hospital admission with prolapse is 2.04 per 1000 person-years of risk. Age, parity, calendar period and weight were significantly associated with risk of an inpatient admission with prolapse after adjustment for principal confounding factors. Significant trends were observed with regard to smoking status and obesity (Quetelet Index) at entry to the study and risk of prolapse. Social class, oral contraceptive use and height were not significantly associated with risk of prolapse. The incidence of prolapse which required surgical correction following hysterectomy was 3.6 per 1000 person-years of risk. The cumulative risk rises from 1% three years after a hysterectomy to 5% 15 years after hysterectomy. The risk of prolapse following hysterectomy is 5.5 times higher (95% CI 3.1-9.7) in women whose initial hysterectomy was for genital prolapse as opposed to other reasons. CONCLUSION: Among the potential risk factors that were investigated, parity shows much the strongest relation to prolapse.

Adult↗
PubMed1997

Comparison of postal version of the Frenchay Activities Index with interviewer-administered version for use in people with stroke.

OBJECTIVE: To assess the agreement between postal and interviewer-administered versions of the Frenchay Activities Index (FAI) and to assess the criterion validity of the postal version, using interviewer administration as a gold standard. DESIGN: Comparison of responses to FAI administered by post and then by interview (median delay 10 days). SUBJECTS: Forty-eight Oxfordshire residents admitted to hospital with acute stroke between 1 August 1994 and 31 January 1995 and discharged alive within six months of their stroke. RESULTS: The limits of agreement of the total FAI score are from -5.4 to 7.2. The kappa statistic for each of the 15 individual items that make up the FAI ranged from 0.35 to 1. For nine items, agreement was moderate or fair, and for six items, agreement was good or very good. The mean difference between the overall scores was 0.9 (95% confidence interval: -0.1 to 1.9). The correlation between the overall scores was 0.94 (Spearman's rank correlation coefficient). CONCLUSION: The postal version of the FAI is a satisfactory alternative to direct administration, but poor agreement in scores for individual patients emphasizes that the two approaches should not be used sequentially to monitor individual patients.

Activities of Daily Living↗
PubMed1996

Health status measurement and the assessment of medical care.

This article reviews the role of health status measures in the assessment of medical care. It is argued that such measures are of only limited value in assessing the performance of health care professionals and institutions because of confounding factors, problems of data collection and the play of chance. Nevertheless, health status measures should be incorporated as outcome measures into clinical trials since they can provide information on how individuals and institutions can improve performance and give health policy makers information about the effectiveness of interventions. It is concluded that the development of simpler measures of performance would be more practical than trying to overcome the limitations of health status measures in monitoring the quality of health care institutions.

Health Policy↗