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K McPherson

Publications and source records attributed to K McPherson.

At least 37 records · Page 2Linked to original sources
PubMed2001

Determinants of HIV prevalence amongst female IDU in Madrid.

OBJECTIVE: To explore the multitude possible factors associated with HIV in a population of female injecting drug users (IDUs) in Madrid, Spain. DESIGN: A cross-sectional study was undertaken and because of the lack of sampling frame in this population, a convenience sample was recruited from drug treatment, methadone services and street settings. METHODS: Face to face interviews were conducted with 304 female IDUs during October 1995-March 1996. HIV status was determined from antibody testing of blood samples or from written confirmation of HIV test results from a physician. A hierarchical logistic regression model was used to identify direct and indirect relationships with HIV prevalence. RESULTS: HIV prevalence in the sample of female IDUs for which HIV status was known (n = 262) was 63%. Factors independently associated with HIV prevalence in the regression analysis included: having a regular HIV positive sexual partner [odds ratio (OR): 12.2], age over 34 years (OR: 3.4), no fixed address (OR: 2.9), co-infection with a sexually transmitted infection (STI) in the last year (OR: 2.8) and ever shared needles (OR: 2.6). CONCLUSIONS: The documentation of the context of risk behaviour in female IDU is important to predict the course of the epidemic and to develop prevention strategies. The sexual partners of female IDUs in Spain are important components in explaining the HIV epidemic in this population as other risk factors, including high risk drug taking behaviour. The findings also highlight the need to target homeless IDUs women and inmate women with outreach services offering preventive interventions. More effective STI prevention and control strategies are also warranted.

Adult↗
PubMed2001

Evidence for inadequate construct validity of the Disease Repercussions Profile in people with rheumatoid arthritis.

OBJECTIVE: To re-evaluate the construct validity of the Disease Repercussions Profile (DRP), a measure of handicap in arthritis populations. METHODS: We used the multitrait-multimethod approach to determine convergent and discriminant validity in a postal survey of randomly selected patients with rheumatoid arthritis who had attended the Wellington Regional Rheumatology Unit since 1988. Respondents (n=142) completed the following self-report instruments: Disease Repercussions Profile, EuroQol EQ-5D, Health Assessment Questionnaire, London Handicap Scale and WHOQOL-BREV. RESULTS AND CONCLUSIONS: The pattern of correlation supported the construct validity of the dichotomous response question (DRP domain affected or not) for the activity and relationships domain, provided ambiguous support for the appearance and emotion domain and no support for the social and financial domains. There was no support for construct validity of any of the domains on the importance rating part of the DRP. We suggest that the DRP be interpreted cautiously in aggregated group data.

Arthritis, Rheumatoid↗
PubMed2001

Mortality in England and Wales attributable to current alcohol consumption.

STUDY OBJECTIVE: To estimate the number of deaths attributable to current alcohol consumption levels in England and Wales by age and sex. DESIGN: Epidemiological approach using published relative risks and population data. SETTING: England and Wales. MAIN OUTCOME MEASURES: Numbers of deaths by age and sex and years of life lost for alcohol related conditions. RESULTS: Because of the cardioprotective properties of alcohol, it is estimated that there are approximately 2% fewer deaths annually in England and Wales than would be expected in a non-drinking population. This proportion varies greatly by age and sex and only among men aged over 55 years and women aged over 65 years is there likely to be found a net favourable mortality balance. It is also estimated that there were approximately 75 000 premature years of life lost in England and Wales in 1996 attributable to alcohol consumption. The main causes of alcohol attributable mortality among the young include road traffic fatalities, suicide and alcoholic liver disease. CONCLUSIONS: At a population level, current alcohol consumption in England and Wales may marginally reduce mortality. However, the benefit is disproportionately found among the elderly. Estimating alcohol attributable mortality by age and sex may be a useful indicator for developing alcohol strategies. More research into the possible effect modifications of pattern of consumption, beverage type, age and gender will enable these estimates to be improved.

Accidents↗
PubMed2001

Working and learning together: good quality care depends on it, but how can we achieve it?

Educating healthcare professionals is a key issue in the provision of quality healthcare services, and interprofessional education (IPE) has been proposed as a means of meeting this challenge. Evidence that collaborative working can be essential for good clinical outcomes underpins the real need to find out how best to develop a work force that can work together effectively. We identify barriers to mounting successful IPE programmes, report on recent educational initiatives that have aimed to develop collaborative working, and discuss the lessons learned. To develop education strategies that really prepare learners to collaborate we must: agree on the goals of IPE, identify effective methods of delivery, establish what should be learned when, attend to the needs of educators and clinicians regarding their own competence in interprofessional work, and advance our knowledge by robust evaluation using both qualitative and quantitative approaches. We must ensure that our education strategies allow students to recognise, value, and engage with the difference arising from the practice of a range of health professionals. This means tackling some long held assumptions about education and identifying where it fosters norms and attitudes that interfere with collaboration or fails to engender interprofessional knowledge and skill. We need to work together to establish education strategies that enhance collaborative working along with profession specific skills to produce a highly skilled, proactive, and respectful work force focused on providing safe and effective health for patients and communities.

Cooperative Behavior↗
PubMed2001

Preferences and understanding their effects on health.

Preference for a particular intervention may, possibly via complicated pathways, itself confer an outcome advantage which will be subsumed in unblind randomised trials as part of the measured effectiveness of the intervention. Where more attractive interventions are compared with less attractive ones, any difference could therefore be a consequence of attractiveness and not its intrinsic worth. For health promotion interventions this is clearly important, but we cannot tell how important it is for therapeutic interventions without special studies to measure or refute such effects. These are difficult to do and are complex. Until the therapeutic effects of preference itself are more clearly understood, understanding the true therapeutic effects will be compromised, at least in principle.

Bias↗
PubMed2001

Factors influencing rate of Barthel Index change in hospital following stroke.

BACKGROUND AND PURPOSE: Randomized controlled trials of specific interventions in stroke rehabilitation are few. In using this study design to compare different rehabilitation interventions or different intensity of those interventions, measuring disability status at a fixed time point is one outcome option. In order for this approach to be valid, factors that might independently affect the speed of disability change have to be matched at baseline. We sought to investigate the impact of different factors on rate of disability change following stroke. METHODS: A prospective hospital-based study of consecutive patients admitted to each of three general hospitals in Wellington, New Zealand with acute stroke. Patients were assessed using the Barthel Index (BI, scored 0-20) within a few days of stroke and fortnightly until hospital discharge. Strokes were classified using the Oxfordshire Community Stroke Project classification. MAIN OUTCOME MEASURE: Barthel Index rate of change (BRC) computed from the difference between the first and last hospital BI scores divided by the time in weeks between these assessments. RESULTS: Of 104 subjects with two or more disability assessments in hospital, BRC was a mean 1.26 units per week (95% confidence interval (CI) 0.97, 1.56). The only factors significantly associated with BRC on univariate analysis were stroke type, pre-stroke Modified Rankin Scale (MRS) and pre-stroke London Handicap Score. In a general linear model analysis of covariance, stroke type (p = 0.015) and pre-stroke MRS (p < 0.001) remained significant. The mean BRC for lacunar infarcts (1.76 units per week, 95% CI 1.22, 2.30) was over three times that of total anterior circulation infarcts (0.48 units per week, 95% CI 0.20, 0.76). CONCLUSIONS: Future randomized controlled trials of rehabilitation interventions for stroke in hospitalized patients need to allow for pre-stroke level of dependence and stroke type in the study design, either excluding particular patients or ensuring even randomization of these key variables if speed of disability change is to be a valid outcome variable.

Aged↗
PubMed2001

Systematic review of the prospective cohort studies on meat consumption and colorectal cancer risk: a meta-analytical approach.

The relation between meat consumption and colorectal cancer risk remains controversial. In this report, we quantitatively reviewed the prospective observational studies that have analyzed the relation between meat consumption and colorectal cancer. We conducted electronic searches of MEDLINE, EMBASE, and CANCERLIT databases through to the end of June 1999 and manual searches of references from retrieved articles. We used both fixed and random-effects meta-analytical techniques to estimate the overall association and to investigate possible sources of heterogeneity among studies. Thirteen studies were eligible for inclusion in the meta-analysis. Pooled results indicate that a daily increase of 100 g of all meat or red meat is associated with a significant 12-17% increased risk of colorectal cancer. The marginally significant between-study heterogeneity for all meat and red meat was explained by a number of study-level covariates. A significant 49% increased risk was found for a daily increase of 25 g of processed meat. The individual study estimates for processed meat showed no detectable heterogeneity. On the basis of this quantitative review of prospective studies, the overall association between meat consumption and risk of colorectal cancer appears to be positive, with marginal heterogeneity between studies. The finding for processed meat and data from experimental studies suggests that it may also be an important predictor of colorectal cancer risk. However, because only a few of the studies reviewed here attempted to examine the independent effect of meat intake on colorectal cancer risk, the possibility that the overall association may be confounded or modified by other factors cannot be excluded.

Adult↗
PubMed2000

Cancer patients' information needs and information seeking behaviour: in depth interview study.

OBJECTIVES: To explore why cancer patients do not want or seek information about their condition beyond that volunteered by their physicians at times during their illness. DESIGN: Qualitative study based on in-depth interviews. SETTING: Outpatient oncology clinics at a London cancer centre. PARTICIPANTS: 17 patients with cancer diagnosed in previous 6 months. MAIN OUTCOME MEASURES: Analysis of patients' narratives to identify key themes and categories. RESULTS: While all patients wanted basic information on diagnosis and treatment, not all wanted further information at all stages of their illness. Three overarching attitudes to their management of cancer limited patients' desire for and subsequent efforts to obtain further information: faith, hope, and charity. Faith in their doctor's medical expertise precluded the need for patients to seek further information themselves. Hope was essential for patients to carry on with life as normal and could be maintained through silence and avoiding information, especially too detailed or "unsafe" information. Charity to fellow patients, especially those seen as more needy than themselves, was expressed in the recognition that scarce resources-including information and explanations-had to be shared and meant that limited information was accepted as inevitable. CONCLUSIONS: Cancer patients' attitudes to cancer and their strategies for coping with their illness can constrain their wish for information and their efforts to obtain it. In developing recommendations, the government's cancer information strategy should attend to variations in patients' desires for information and the reasons for them.

Adaptation, Psychological↗
PubMed2000

Bed numbers. Inadmissible evidence.

Little research has been done on the number of intensive care beds the UK needs, and provision varies widely across the country. There is no indication of systematic under-provision of intensive care unit beds in the UK. There is confusion about appropriate referrals and admissions. Research suggests that with the current number of beds there are 2,100-2,500 avoidable deaths a year. But it is unclear how many of these would be avoided by providing extra beds.

Health Care Surveys↗
PubMed2000

Value of drug-licensing documents in studying the effect of postmenopausal hormone therapy on cardiovascular disease.

BACKGROUND: In a previous study of pooled data from published trials, we found no evidence to support the claim that postmenopausal hormone therapy (PHT) is associated with a decrease in cardiovascular disease. The purpose of this study was to see whether reports of clinical trials attached to drug-licensing applications in Finland could be obtained for scientific purposes, whether they are useful for studying cardiovascular events resulting from PHT, and if so, whether these unpublished reports corroborate the results of published reports. METHODS: Since clinical trials in drug-licensing documents are confidential, we had to obtain special permission from the Ministry of Social Affairs and Health to use the data for research purposes. After permission was granted, we studied the clinical sections of licensing documents for PHT drugs sent by drug companies to the Finnish Drug Agency. We aimed to identify trials that compared PHT and a placebo (or no therapy, or vitamin-mineral drugs), and that reported on cardiovascular and thromboembolic events or superficial phlebitis. New trials were identified and their data were pooled with those of published trials. FINDINGS: 17 licensing applications for drugs used as PHT were found. The number, type, and quality of reporting of clinical trials varied widely between applications. The trials and their reporting of unanticipated adverse events were mostly inadequate. Six new trials (ie, those fulfilling the inclusion criteria and not included in our earlier report) were found. The new trials added little to the conclusions of previously published studies: the calculated odds ratios of cardiovascular and thromboembolic events for women taking PHT versus those not taking it was 1.97 (95% CI 0.84-4.63), compared with 1.65 (0.65-4.21) in our previous study. INTERPRETATION: In this case, unpublished trials added only a little to the data available from published trials, mainly due to the type of clinical data used in the licensing applications. The new data did not change the previous conclusion that clinical trials do not support a beneficial effect of PHT on cardiovascular diseases.

Adult↗
PubMed2000

Faith, hope, and charity: an in-depth interview study of cancer patients' information needs and information-seeking behavior

OBJECTIVE: To explore why cancer patients do not want or seek information about their condition beyond that volunteered by their physicians at times during their illness. DESIGN: Qualitative study based on in-depth interviews. SETTING: Outpatient oncology clinics at a London cancer center. PARTICIPANTS: 17 patients with cancer diagnosed in previous 6 months. Main outcome measures Analysis of patients' narratives to identify key themes and categories. RESULTS: While all patients wanted basic information on diagnosis and treatment, not all wanted further information at all stages of their illness. Three overarching attitudes to their management of cancer limited patients' desire for and subsequent efforts to obtain further information : faith, hope, and charity. Faith in their doctor's medical expertise precluded the need for patients to seek further information themselves. Hope was essential for patients to carry on with life as normal and could be maintained through silence and avoiding information, especially too detailed or "unsafe" information. Charity to fellow patients, especially those seen as more needy than themselves, was expressed in the recognition that scarce resources-including information and explanations-had to be shared and meant that limited information was accepted as inevitable. CONCLUSIONS: Cancer patients' attitudes to cancer and their strategies for coping with their illness can constrain their wish for information and their efforts to obtain it. In developing recommendations, the government's cancer information strategy should attend to variations in patients' desires for information and the reasons for them.

Journal Article↗