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Biomedical subjects

L Owen

Publications and source records attributed to L Owen.

At least 19 recordsLinked to original sources
PubMed2001

General Practitioners' views on the provision of nicotine replacement therapy and bupropion.

BACKGROUND: Nicotine replacement therapies (NRT) and a new drug, bupropion, are licensed in several countries as aids to smoking cessation. General practitioners (GPs) play a crucial role in recommending or prescribing these medications. In the UK there has been discussion about whether the medications should be reimbursable by the National Health Service (NHS). This study assessed English GPs' attitudes towards reimbursement of NRT and bupropion. METHODS: Postal survey of a randomly selected national sample of GPs; 376 GPs completed the questionnaire after one reminder; effective response rate: 53%. There was no difference between the responses of GPs who responded to the initial request and those who responded only after a reminder suggesting minimal bias due to non-response. RESULTS: Attitudes of GPs were remarkably divided on most issues relating to the medications. Forty-three percent thought that bupropion should not be on NHS prescription while 42% thought that it should be (15% did not know); Fifty percent thought that NRT should not be on NHS prescription while 42% thought it should be (8% did not know). Requiring that smokers attend behavioural support programmes to be eligible to receive the medications on NHS prescription made no appreciable difference to the GPs' views. GPs were similarly divided on whether having the medications reimbursable would add unacceptably to their workload or offer a welcome opportunity to discuss smoking with their patients. A principal components analysis of responses to the individual questions on NRT and bupropion revealed that GPs' attitudes could be understood in terms of a single 'pro-con' dimension accounting for 53% of the total variance which made no distinction between the two medications. CONCLUSIONS: GPs in England appear to be divided in their attitudes to medications to aid smoking cessation and appear not to discriminate in their views between different types of medication or different aspects of their use. This suggests that their attitudes are generated by quite fundamental values. Addressing these values may be important in encouraging GPs to adhere more closely to national and international guidelines.

Antidepressive Agents, Second-Generation↗
PubMed2001

Contracting for smoking and pregnancy interventions: current practice across England.

In order to understand the commissioning of smoking and pregnancy interventions across England prior to the implementation of the Government's national strategy, "Smoking Kills: A White Paper on Tobacco" in 1998, a postal survey was undertaken amongst all 96 Health Authorities (purchasers) and 207 Maternity Service Provider Units (providers) in England. The main outcome measures included the type and duration of contract agreements/service specifications, the level and nature of smoking and pregnancy interventions, barriers to commissioning smoking and pregnancy interventions, data collection and monitoring of activity and quality. A quarter of health authorities were encouraging smoking cessation through contract agreements. The level and complexity of contract agreements and service specifications varied tremendously. Existing smoking and pregnancy interventions were diverse and ad hoc. Data collection and monitoring were haphazard and inconsistent making cross-country comparisons difficult. The commissioning of smoking and pregnancy interventions across England during 1997 and 1998 appeared to be inadequately prioritised. These findings offer a benchmark for observing changes in practice following the recent change of government policy.

Contract Services↗
PubMed2001

Randomized controlled trial of a midwife-delivered brief smoking cessation intervention in pregnancy.

OBJECTIVE: To evaluate the efficacy of a brief smoking cessation intervention with pregnant women practicable routinely by midwives. DESIGN: Midwives were randomized to deliver the experimental intervention or usual care. The 10-15-minute intervention was based on brief counselling, written materials, arrangements for continuing self-help support and feedback on expired-air carbon monoxide levels. The intervention was tailored to the women's needs: those who did not want to stop smoking received a brief motivational intervention, those who wanted to stop received an intervention designed to assist them and those that had stopped recently (recent ex-smokers) received a relapse prevention intervention. SETTING: Booking interviews with pregnant women in nine hospital and community trusts. SUBJECTS: A total of 1120 pregnant women in the third month of pregnancy (249 recent ex-smokers and 871 current smokers). MAIN OUTCOME MEASURES: Three indicators of biochemically validated abstinence were collected. Continuous abstinence for at least 3 months prior to delivery, point prevalence abstinence immediately post-delivery, and continuous abstinence from 3 months pre-delivery to 6 months post-delivery. RESULTS: Only a small proportion of the women who would have been eligible to take part in the trial were actually recruited by 178 recruiting midwives, with lack of time being cited as the main barrier. The intervention and usual care groups differed in post-delivery point prevalence abstinence rates for recent ex-smokers (65% vs. 53%, p < 0.05, one-tailed), but not in other outcome measures. Overall, 54% of "recent ex-smokers" at booking and 7% of "current smokers" at booking had been abstinent for at least 3 months at the time of delivery, and 23% and 3%, respectively, were still abstinent by the time the child was 6 months old (i.e. 12 months post-intervention). Smoking status at follow-up was predicted by dependence indexed by time to first cigarette in the morning. CONCLUSIONS: A brief "one-off" smoking cessation intervention by midwives does not seem to be a practicable or effective method of helping pregnant smokers to stop. Other options such as tailored self-help materials and telephone counselling and other specialist treatments should be examined. Current smoking cessation rates in pregnancy are very low.

Birth Weight↗
PubMed2001

Smoking cessation and smoking patterns in the general population: a 1-year follow-up.

OBJECTIVE: To assess the prevalence of motivation and behaviours relating to smoking cessation and attempts at harm minimization and the stability of these over a 1-year period; to identify demographic, social, behavioural and psychological predictors of attempts to stop smoking and the success of these attempts. DESIGN: Face-to-face interviews were carried out with a national sample of UK smokers in April/May 1996 with follow-up 1 year later. SUBJECTS: The original response rate was 61% (1478 of 1911 adult smokers), and of these 1012 were followed-up 1 year later (68% of those who were originally contactable). RESULTS: Thirty-one per cent of smokers reported making at least one quit attempt during the follow-up period and 17% made a quit attempt in the first 9 months of that period. Of these 29% were still not smoking at least 3 months later. Fifty-one per cent of smokers had tried to cut down in the year leading up to the first survey. There was a fair degree of consistency over time in individual smokers' desires and intentions to stop smoking across both surveys and in the incidence of quit attempts and attempts to cut down. Beliefs about the effects of smoking on future health and having a partner who disliked their smoking were positively associated with making a quit attempt at follow-up while reporting enjoying smoking at baseline was negatively associated with making a quit attempt at follow-up. Time to first cigarette of the day and age of starting smoking were positively associated with success of quit attempts. CONCLUSIONS: Motivation and behaviours relating to smoking cessation are prevalent and fairly stable over time. Different factors appear to be related to attempts to stop and the success of those attempts. Interventions to increase smoking cessation in the population should take account of this.

Adult↗
PubMed2001

Saliva cotinine as indicator of cigarette smoking in pregnant women.

OBJECTIVE: To assess use of saliva cotinine as a quantitative objective index of smoking in pregnant women. DESIGN: National survey using quota sampling of pregnant women in England. Face-to-face interviews were conducted in the respondents' own homes. SETTING: Respondents' homes. PARTICIPANTS: N = 1009 pregnant women, mean age = 27.9 years. MAIN OUTCOME MEASURES: Saliva cotinine and current smoking status. RESULTS: Saliva cotinines revealed under-reporting among pregnant women by about 3%. CONCLUSIONS: Pregnant women under-report current smoking status. The optimal cut-off point for validating smoking status among this group requires further research. The results also highlight the need for an improved understanding of the effects of pregnancy on the metabolism of nicotine.

Adult↗
PubMed2001

Phyllodes tumors of the breast: correlation of nucleolar organizer regions with histopathological malignancy grading, flow cytometric DNA analysis and clinical outcome.

To examine whether nucleolar organizer regions detected by argyrophilia (Ag-NOR counts) can be used as a prognostic indicator in phyllodes tumors of the breast, and to compare its usefulness with that of DNA flow cytometric analysis, 28 cases of breast phyllodes tumors (including 15 benign, two borderline and 11 malignant tumors) were subjected to Ag-NOR staining and counting as well as DNA flow cytometric analysis. S-phase fraction and DNA ploidy analysis showed useful trends for improving outcome predictions in malignant phyllodes tumors. However, high Ag-NOR counts were significant in predicting survival status (P = 0.013) and reached near statistical significance in predicting survival times (P = 0.07). In predicting survival status, results for Ag-NOR counts were significantly better than those for ploidy analysis (P = 0.02) and S-phase fraction (P < 0.01). Only S-phase fraction was significantly predictive of survival times (P = 0.025). It is concluded that Ag-NOR counts and DNA flow cytometric analysis, easily performed using paraffin sections, give information that can improve predictions made by histopathological classification. Ag-NOR counts are significant in predicting survival in the presence of histopathological features of malignancy.

Adolescent↗
PubMed2000

Deliberate sulphonylurea poisoning mimicking hyperinsulinaemia of infancy.

A 6 month old child presenting with seizures was found to be hypoglycaemic secondary to hyperinsulinism. A family history of type II diabetes prompted estimation of sulphonylurea in the baby's blood, which was found to be high. A multidisciplinary case conference concluded that the sulphonylurea ingestion was likely to be the result of Munchausen syndrome by proxy. When investigating hypoglycaemia of infancy this possibility should be considered.

Diagnosis, Differential↗
PubMed2000

Impact of a telephone helpline for smokers who called during a mass media campaign.

OBJECTIVE: To evaluate the impact of a telephone helpline (Quitline) with additional support (written information) on callers who use the service during a mass media campaign. DESIGN: Telephone recall surveys of callers to the helpline carried out two months and one year after their initial call. SETTING: Telephone helpline. SUBJECTS: Callers to the helpline. MAIN OUTCOME MEASURES: Smoking behaviour change among callers to the helpline at two months and one year. RESULTS: At one year 22% (95% confidence interval (CI) 18.4% to 25.6%) of smokers reported that they had stopped smoking. Assuming that those who refuse to take part in the one year follow up are continuing smokers and a further 20% of reported successes fail biochemical validation, this yields an adjusted quit rate of 15. 6% (95% CI 12.7% to 18.9%) at one year. Among ex-smokers, 41% (95% CI 34.3% to 47.7%) reported that they were still not smoking at one year. The adjusted figure for ex-smokers at one year is 29% (95% CI 23.3% to 34.8%). Of those who resumed smoking 28% were smoking less than they had been initially. Currently Quitline receives around half a million calls in the course of one year, 93% of whom are phoning for themselves. This represents 4.2% of the total population of adults smokers in England. CONCLUSION: The Health Education Authority's advertising campaign was extremely successful in generating calls to the helpline. Very large numbers of smokers from diverse backgrounds, including the key groups highlighted in the UK government's recent proposals on tobacco, called the Quitline, which appeared to be very successful in helping these callers to stop smoking. For a single intervention to reach 4.2% of the total population of adult smokers in England is a major achievement. This makes Quitline a very promising model for public health intervention programs.

Adolescent↗
PubMed1997

Rare earth elements as nonabsorbable fecal markers in studies of iron absorption.

The use of rare earth elements as nonabsorbable fecal markers for studies of iron absorption from sources labeled extrinsically with stable isotopes was evaluated. On 3 successive days 13 healthy fasting adults were given different stable isotopes of iron with samarium, ytterbium, or dysprosium. On day 1, three meals were given with 57Fe (1 mg per meal) plus samarium (0.33 mg per meal); on day 2, identical meals (taken with a calcium supplement to reduce iron bioavailability) were given with equivalent amounts of 58Fe-labeled iron and ytterbium; on day 3, a well-absorbed reference dose of 54Fe (3 mg) was given with 1 mg Dy. A complete fecal collection was carried out for 5-9 d and each stool was analyzed for rare earth elements by inductively coupled plasma-mass spectrometry and iron isotopes by thermal ionization quadrupole mass spectrometry. Mean recovery of rare earth elements was 101%, indicating that they are totally unabsorbed. The excretory pattern of the iron isotopes and the rare earth elements was very similar; the correlation coefficients between samarium and 57Fe, ytterbium and 58Fe, and dysprosium and 54Fe were 0.992, 0.989, and 0.988, respectively (P < 0.001). Iron absorption was calculated as the difference between isotope dose and fecal excretion. Mean (+/-SEM) iron absorption was 16.7 +/- 2.4%, 4.3 +/- 1.6%, and 40.3 +/- 3.1% on days 1-3, respectively. Predicted values estimated from the first 4 d of pooled feces, using the rare earth element recovery data to produce corrected figures for unabsorbed isotope, were in close agreement: 19.1 +/- 2.1%, 4.6 +/- 1.7%, and 40.8 +/- 3.1%, respectively (P < 0.001). With the diet of medium iron bioavailability and with the highly bioavailable reference dose it was possible to predict iron absorption accurately from only one or two stools, provided that they were sufficiently enriched with isotope and a rare earth element.

Absorption↗
PubMed1997

The named nurse: patient and nurse expectations.

The named nurse concept was introduced to provide patients with one nurse responsible for their care during a hospital stay. Research into patient and nurse expectations of the role is needed if the named nurse concept is to be evaluated.

Attitude of Health Personnel↗
PubMed1995

Value from resources in Southampton University Hospitals NHS Trust.

Outlines the use of the "value from resources" approach to build bridges between clinicians and managers. The simple but powerful use of graphical interactive presentations has resulted in increased staff awareness of how quality improvement and resource utilization are inextricably linked.

Health Resources↗
PubMed1994

Evaluation of a mass media campaign on smoking and pregnancy.

Two surveys were conducted among pregnant women throughout England, before (n = 625) and after (n = 607) a mass media campaign on smoking and pregnancy targeted at women aged 15-24 years, in the social grade C2DE. The majority of the post-campaign sample recalled having seen at least one of the campaign's series of press advertisements. There was a significant increase among this sample in those considering smoking to be very dangerous to the unborn child, in those understanding the term passive smoking and in those considering passive smoking to be very dangerous. During the campaign there was a 14% increase in the number of calls to a cessation helpline from pregnant women. Over the campaign there were no significant changes in smoking prevalence and consumption among pregnant women or partners or in the numbers of partners offering suggestions to pregnant women about their smoking behaviour.

Adolescent↗