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Biomedical subjects

J Weinman

Publications and source records attributed to J Weinman.

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

Patients' interpretation of symptoms as a cause of delay in reaching hospital during acute myocardial infarction.

OBJECTIVE: To examine whether the association between expected symptoms of acute myocardial infarction and actual symptoms predicted delay in reaching hospital and help seeking behaviour. DESIGN: During hospital convalescence, participants completed a structured interview designed to measure symptom experience and help seeking behaviour following the onset of symptoms of acute myocardial infarction. PATIENTS: 88 patients admitted to hospital with their first myocardial infarction MAIN OUTCOME MEASURES: Delay in reaching hospital from onset of worst symptoms, obtained from ambulance and hospital records. RESULTS: The most common symptoms expected by patients with myocardial infarction were central chest pain (76%), radiating arm or shoulder pain (34%), and collapse (26%). The most common symptoms experienced were sweats or feeling feverish (78%), chest pain (64%), and arm, shoulder, or radiating pain (66%). A mismatch between symptoms experienced and those expected occurred in 58% of patients, and was associated with delay. Patients who experienced a mismatch between expectation and actual symptoms also were more likely to have a third party decide to call for help. CONCLUSIONS: The experience and interpretation of symptoms is an important source of delay and help seeking following onset of myocardial infarction symptoms.

Aged↗
PubMed2000

Perceptions of multiple risk factors for heart attacks.

There is increasing evidence that in some diseases such as coronary heart disease, risk factors may interact synergistically, resulting in greater likelihood of disease than would be produced by the sum of the risk factors. These two studies aimed to examine the extent to which 210 undergraduate students and 28 heart attack patients perceive risk factors to combine synergistically. Respondents read one of four vignettes, describing information about risk factors (with high and low smoking and family history), and estimated a man's likelihood of a heart attack in a hypothetical case. In both studies an interaction was found with either a family history or smoking eliciting ratings of high likelihood of heart attack, providing no evidence of synergistic models. This finding may reflect respondents' beliefs or the insensitivity of this paper-and-pencil method in detecting synergistic effects.

Adult↗
PubMed1999

Positive effects of illness reported by myocardial infarction and breast cancer patients.

This study investigated the positive effects or changes that patients identified in their lives following a myocardial infarction (MI) or breast cancer. One hundred and forty-three patients were assessed in hospital following a first-time MI and 52 breast cancer patients were assessed on referral for radiotherapy. Approximately 3 months later both groups were asked if any positive changes had taken place in their lives following their illness. Patients' written responses to a single open-ended question were read independently by three judges who identified seven major positive themes. Approximately 60% of each patient group reported positive changes from their illness and the reporting of such changes was unrelated to illness severity. The most common theme reported by MI patients was healthy lifestyle change (68%), whereas, for breast cancer patients, it was improved close relationships with others (33%). These results are discussed in terms of the way patients make sense of and adapt to chronic illness.

Adaptation, Psychological↗
PubMed1999

Patients' beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness.

The aim of this cross-sectional study was to quantify patients' personal beliefs about the necessity of their prescribed medication and their concerns about taking it and to assess relations between beliefs and reported adherence among 324 patients from four chronic illness groups (asthma, renal, cardiac, and oncology). The findings revealed considerable variation in reported adherence and beliefs about medicines within and between illness groups. Most patients (89%) believed that their prescribed medication was necessary for maintaining health. However, over a third had strong concerns about their medication based on beliefs about the dangers of dependence or long-term effects. Beliefs about medicines were related to reported adherence: higher necessity scores correlated with higher reported adherence (r=0.21, n=324, p<0.01) and higher concerns correlated with lower reported adherence (r=0.33, n=324, p<0.01). For 17% of the total sample, concerns scores exceeded necessity scores and these patients reported significantly lower adherence rates (t=-4.28, p<0.001). Stepwise multiple linear regression analysis showed that higher reported adherence rates were associated with higher necessity-concerns difference scores (beta=0.35, p<0.001), a diagnosis of asthma (beta= -0.31, p<0.001), a diagnosis of heart disease (beta=0.19, p<0.001), and age (beta=0.22, p<0.001). Gender, educational experience, or the number of prescribed medicines did not predict reported adherence. Medication beliefs were more powerful predictors of reported adherence than the clinical and sociodemographic factors, accounting for 19% of the explained variance in adherence. These data were consistent with the hypothesis that many patients engage in an implicit cost-benefit analysis in which beliefs about the necessity of their medication are weighed against concerns about the potential adverse effects of taking it and that these beliefs are related to medication adherence.

Adult↗
PubMed1999

Comparison of characteristics of the nodX genes from various Rhizobium leguminosarum strains.

We have analyzed the nucleotide sequences of the nodX genes from two strains of Rhizobium leguminosarum bv. viciae able to nodulate Afghan peas (strains A1 and Himalaya) and from two strains of R. leguminosarum bv. trifolii (ANU843 and CSF). The nodX genes of strains A1 and ANU843 were shown to be functional for the induction of nodules on Afghan peas. To analyze the cause of phenotypic differences of strain A1 and strain TOM we have studied the composition of the lipochitin-oligosaccharides (LCOs) produced by strain A1 after induction by the flavonoid naringenin or various pea root exudates. The structural analysis of the LCOs by mass spectrometry revealed that strain A1 synthesizes a family of at least 23 different LCOs. The use of exudates instead of naringenin resulted only in quantitative differences in the ratios of various LCOs produced.

Amino Acid Sequence↗
PubMed1999

Why patients do not attend cardiac rehabilitation: role of intentions and illness beliefs.

OBJECTIVE: Many patients fail to attend cardiac rehabilitation. Attempts to identify sociodemographic or clinical predictors of non-attendance have not been very successful; therfore, this study aimed to determine whether the illness beliefs held during hospitalisation by patients who had suffered acute myocardial infarction or who had undergone coronary artery bypass graft surgery could predict cardiac rehabilitation attendance. SUBJECTS AND METHODS: 152 patients were prospectively studied of whom 41% had attended cardiac rehabilitation at six months. RESULTS: In addition to being older, less aware of their cholesterol values, and less likely to be employed, non-attenders were less likely to believe their condition was controllable and that their lifestyle may have contributed to their illness. CONCLUSION: It should now be determined whether interventions aimed at optimising certain perceptions could promote cardiac rehabilitation uptake among those patients who could benefit the most.

Age Factors↗
PubMed1998

Illness perceptions, coping and functioning in patients with rheumatoid arthritis, chronic obstructive pulmonary disease and psoriasis.

The present cross-sectional study analyzed the extent to which illness perceptions and coping strategies (as measured by the Illness Perception Questionnaire and the Utrecht Coping List, respectively) are associated with levels of daily functioning, as indicated by the Medical Outcomes Study SF-20, and disease-specific measures in 244 adults: 84 with rheumatoid arthritis (RA); 80 with chronic obstructive lung disease (COPD); and 80 with psoriasis. The results of stepwise regression analyses indicated that a strong illness identity, passive coping, belief in a long illness duration, belief in more severe consequences, and an unfavorable score on medical variables were associated with worse outcome on disease-specific measures of functioning and on general role and social functioning. Coping by seeking social support and beliefs in controllability/curability of the disease were significantly related to better functioning. The implications of these findings for future interventions and research are discussed.

Activities of Daily Living↗
PubMed1998

Objectives of genetic counselling: differing views of purchasers, providers and users.

BACKGROUND: This study aimed to compare the views of purchasers, providers and users about the objectives of genetic counselling. METHODS: A modified Delphi technique was used, incorporating two postal questionnaires that were sent to six study groups with a three-month interval: purchasers (public health doctors (n = 37) and regional advisers in general practice (n = 35)); providers (clinical geneticists (n = 33) and genetic counsellors (n = 25)); and users (out-patients (n = 36) and members of genetic support groups (n = 32)). The response rate for the first questionnaire was 115/198 (58 per cent) and for the second, 102/198 (52 per cent). The first questionnaire asked an open-ended question about what the objectives of genetic counselling should be and asked respondents to rank order them. The second questionnaire summarized the views expressed in the first questionnaire and asked respondents to rank order the most frequently cited and most highly ranked five objectives. RESULTS: The five most frequently cited and highly ranked objectives from Questionnaire One were, in descending order: provide information, give support, facilitate decision-making, assess risk and achieve understanding. In response to Questionnaire Two, purchasers differed from providers and users in rating 'facilitate decision-making' more highly than did providers and users. By contrast, providers and users rated 'give information' more highly than did purchasers. CONCLUSIONS: Purchasers hold different views from providers and users about what the objectives of genetic counselling should be. This raises two questions: (1) Which views are or should be most influential in the future development of genetic counselling? (2) By what processes can more than one view on genetic counselling be integrated?

Attitude of Health Personnel↗
PubMed1998

The relationship of health beliefs and psychological mood to patient adherence to oral hygiene behaviour.

Patient adherence to oral hygiene instructions (compliance) is important for the success of periodontal treatment. However, there are many different definitions and measures of what constitute patient adherence. Also, many different models of patient behaviour have been studied, with inconsistent or conflicting findings. The purpose of this study was to explore the relationships between health beliefs (three aspects of dental health locus of control, health values and adherence intent), psychological mood and periodontal outcomes. Complete periodontal data were obtained for 47 untreated patients prior to instruction in oral hygiene, and again 4-6 weeks later. Psychological variables were measured by questionnaire and adherence was measured by reductions in clinical variables (plaque and inflammation). Data were analysed using an item analysis of the questionnaire to assess the internal consistency of the subscales. The results showed overall stability in the psychological variables and reductions in the clinical variables. The main result was a series of negative associations between plaque scores and adherence intent. Inflammatory variables showed some association with psychological constructs related to dependence on external factors.

Adult↗
PubMed1998

Determinants of carer distress in non-acute stroke.

Carers of people with non-acute aphasic and non-aphasic stroke completed questionnaires assessing their distress, perceptions of stroke, generalised self-efficacy, optimism, coping strategies, self-rated physical health and social support. At the same time, their relatives with the stroke were assessed on mood and ability measures. Results showed that whereas stroke disability/aphasia did not account for carer distress, carer factors accounted for a significant amount of the distress.

Adult↗
PubMed1998

A randomized controlled trial of exercise therapy for dizziness and vertigo in primary care.

BACKGROUND: 'Vestibular rehabilitation' (VR) is an increasingly popular treatment option for patients with persistent dizziness. Previous clinical trials have only evaluated the effects of specialist therapy programmes in small, selective, or uncontrolled patient samples. AIM: To determine the benefits of VR compared with standard medical care, using a brief intervention for dizzy patients in primary care. METHOD: Adults consulting their general practitioner (GP) with dizziness or vertigo were randomly assigned to treatment or control groups. Patients in both groups received the same evaluation at baseline, six-week follow-up, and six-month follow-up, comprising examination of nystagmus, postural control, and movement-provoked dizziness, and a questionnaire assessment of subjective status, symptoms, handicap, anxiety, and depression. At baseline and six weeks later, the treatment group also received an individualized 30-minute therapy session, in which they were taught head, eye, and body exercises designed to promote vestibular compensation and enhance skill and confidence in balance. RESULTS: The treatment group (n = 67) improved on all measures, whereas the control group (n = 76) showed no improvement, resulting in a significant difference between the two groups on physical indices of balance and subjective indices of symptoms and distress. Odds ratios for improvement in treated patients relative to untreated patients were 3.1:1 at six weeks (95% CI = 1.4-6.8) and 3.8:1 at six months (95% CI = 1.6-8.7). CONCLUSION: VR is a simple, inexpensive, and beneficial treatment, and may be an appropriate first stage of management for many dizzy patients in primary care.

Adult↗
PubMed1996

Role of patients' view of their illness in predicting return to work and functioning after myocardial infarction: longitudinal study.

OBJECTIVE: To examine whether patients' initial perceptions of their myocardial infarction predict subsequent attendance at a cardiac rehabilitation course, return to work, disability, and sexual dysfunction. DESIGN: Patients' perceptions of their illness were measured at admission with their first myocardial infarction and at follow up three and six months later. SETTING: Two large teaching hospitals in Auckland, New Zealand. SUBJECTS: 143 consecutive patients aged under 65 with their first myocardial infarction. MAIN OUTCOME MEASURES: Attendance at rehabilitation course; time before returning to work; measures of disability with sickness impact profile questionnaire for sleep and rest, social interaction, recreational activity, and home management; and sexual dysfunction. RESULTS: Attendance at the rehabilitation course was significantly related to a stronger belief during admission that the illness could be cured or controlled (t = 2.08, P = 0.04). Return to work within six weeks was significantly predicted by the perception that the illness would last a short time (t = 2.52, P = 0.01) and have less grave consequences for the patient (t = 2.87, P = 0.005). Patients' belief that their heart disease would have serious consequences was significantly related to later disability in work around the house, recreational activities, and social interaction. A strong illness identity was significantly related to greater sexual dysfunction at both three and six months. CONCLUSIONS: Patients' initial perceptions of illness are important determinants of different aspects of recovery after myocardial infarction. Specific illness perceptions need to be identified at an early stage as a basis for optimising outcomes from rehabilitation programmes.

Activities of Daily Living↗
PubMed1996

Intellectual impairment in neurofibromatosis 1.

Intellectual problems are a recognized feature of neurofibromatosis 1 (NF1) but their aetiology is unknown. We investigated the frequency, nature, severity and cause of intellectual impairment in NF1. We undertook neurological and psychometric assessments on 103 patients with NF1 and 105 controls equated for age, sex and socio-economic status. The mean full scale IQ was significantly lower in the NF1 than the control group, 88.6 (SD 14.6) compared with 101.6 (SD 14.2). However, the degree of intellectual impairment was mild and only 8% of NF1 patients had an IQ < 70. The NF1 patients also had significantly poorer reading skills and impaired short term memory. On a computerized performance test battery of complex tasks, the NF1 group had significantly slower mean reaction times and higher error rates than the controls. Overall the patients displayed impaired attention and were slow to develop and adapt strategies for complex and unfamiliar tasks. A particular profile of intellectual deficit did not emerge. The presence of neurological and/or medical complications was weakly associated with a lower mean full scale IQ in NF1 patients. Socio-demographic factors, age or sex differences and the presence of macrocephaly did not contribute to neurocognitive deficit in NF1.

Adolescent↗
PubMed1996

Empowering the patient in the consultation: a pilot study.

This study examined the efficacy of a brief written intervention for primary care patients, designed to increase their level of participation in the consultation. Patients given the intervention leaflet (N = 59) were compared with those given a control leaflet (N = 61) on various consultation process and outcome measures. Psychological and sociodemographic data were also obtained to determine whether these influenced the effects of the intervention. The results showed that the intervention group had significantly longer consultations and asked more questions than the controls. Younger patients and those from social classes 1 and 2 were more likely to benefit from the intervention, but locus of control and self-efficacy scores were not particularly helpful in predicting outcomes. No differences in patient satisfaction were found nor were any negative effects on the doctor observed. A number of explanations are explored and some directions for future research are discussed.

Adolescent↗
PubMed1996

Obstacles and opportunities in designing cancer control communication research for farmworkers on the Delmarva Peninsula.

Little is known about the incidence of cancer among farmworker populations or about effective strategies for communicating with farmworkers about cancer prevention. Some studies suggest that farmworkers may have unusually high incidences of skin and cervical cancers. With these two cancers as the focus, a group of interviewers, researchers, and health communication specialists set out to create, implement, and evaluate a cancer control demonstration project geared toward farmworkers. In 1994, a situation analysis was conducted to identify constraints and opportunities for providing farmworkers with cancer control information and services. The situation analysis provided valuable information to aid in developing intervention and evaluation strategies. This paper outlines how and why the situation analysis was conducted and what was learned with regard to the farmworker population on the Delmarva Peninsula. Living conditions and the local availability of cancer control services are described. Obstacles to conducting research and interventions with farmworkers are highlighted. Based on what was learned, recommendations are made for designing cancer control research and intervention for farmworkers.

Agriculture↗