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Biomedical subjects

L W Chambers

Publications and source records attributed to L W Chambers.

At least 37 records · Page 2Linked to original sources
PubMed1987

Evaluation of public health preschool child developmental screening: the process and outcomes of a community program.

We conducted a randomized controlled trial of a public health and education screening program aimed at all 4,797 four to five year old children registering for kindergarten in three school districts of southern Ontario, Canada. Children received either the Denver Developmental Screening Test (DDST) with a community health intervention program for positive screeness; the DDST with no intervention for positive screenees; or no screening test. The intervention program consisted of referral to the child's physician for assessment; a review conference between the child's teacher and the school health nurse; parent counseling; and monitoring of the child in school by the school health nurse. At the end of the third school year, no differences were found between positive screenees in the community health intervention group and the "no intervention" groups using individual academic achievement, cognitive, and developmental tests. Parents' reports revealed no differences between groups in children's mental, social, and behavioral well-being. However, parents of intervention program children had more worry about their child's school progress suggesting a potentially harmful labeling effect. In comparison to a random sample of children with normal DDST results, or a random sample of children who had randomly not been screened, the children with positive preschool DDSTs had substantially more school problems three years after screening.

Child Development↗
PubMed1986

An epidemiological description of physical, social and psychological problems in multiple sclerosis.

Chronic disorders such as multiple sclerosis have important behavioural consequences on the lives of patients. The purpose of this study was to describe the frequency distribution of psychosocial disability among a referral clinic population of multiple sclerosis patients and to identify associated factors. A cross-sectional survey was conducted of 301 patients using four health indexes to assess quality of life. An 82% response rate was obtained. In the results are presented the frequencies of behavioural problems compared with the general population and a family practice group. While physical function was found to be closely associated with disease severity, psychosocial disability bore little relationship to the underlying disease or to sociodemographic variables including social class. Eighty percent of psychosocial disability remained unexplained. The physical aspects of multiple sclerosis were not predictive of emotional or social morbidity. The major implication of these findings is that the impact of disease on patients, as distinct from the disease itself, should be dealt with as health problems in their own right.

Activities of Daily Living↗
PubMed1986

A study to identify who is the responsible physician for each patient in a teaching hospital.

A one-day study was conducted to confirm evidence of disagreement about which physician was responsible for the care of patients in a teaching hospital. Sixteen percent of the patients reported the responsible physician as someone different from the physician listed on their medical record, and 13% could not provide any physician's name. Significant disagreement was also discovered between the name given by the charge nurse, the patient's identification band, and the face sheet on the patient's chart. Twenty-nine percent of the charts reviewed revealed no documented involvement by the responsible physician within the previous ten days. As a result of the study, the hospital changed its documentation procedures and the hospital and the medical school became aware of the need to improve monitoring of supervision of student physicians.

Hospital Records↗
PubMed1986

Evaluation of placement and coordination of geriatric services using a health program evaluation grid.

This article describes how the Health Program Evaluation Grid method of clarifying program objectives was applied to an innovative program (PCS) set up to assist the placement of the elderly into appropriate long-term care programs/agencies. The advantages and disadvantages of the Grid method are outlined in terms of how the Grid may be used by program managers as their first step in evaluation of a health program for which they are responsible. The Grid method provided a basis for setting evaluation priorities for PCS, and methods of executing the highly ranked evaluation priorities were discussed. The use of the Grid in development of objectives for three other Ontario health programs assisted by the Department of Clinical Epidemiology and Biostatistics of McMaster University has shown further the usefulness of the approach.

Aged↗
PubMed1984

The usefulness of the Denver Developmental Screening Test to predict kindergarten problems in a general community population.

The Denver Developmental Screening Test (DDST) was administered to 2,569 children five to seven months prior to starting kindergarten in September 1980 in a geographically well-defined community. The test was administered by trained public health nurses. At the end of the 1980-1981 school year, all 163 kindergarten teachers in the area completed a rating form for each child in their class. The rating form determined global ratings of: 1) learning abilities; 2) classroom behavior; 3) amount of special attention required; and 4) referrals to special education services outside the classroom. The specificity of the DDST in predicting kindergarten teacher ratings was 99 per cent for all areas. Test sensitivity varied from 5 per cent to 10 per cent in detecting problems in the four areas. The predictive values of an positive test varied from 31 per cent for behavior problems to 62 per cent for extra attention required in the classroom. Negative test predictive values varied from 79 per cent to 93 per cent. These results based on kindergarten teacher ratings suggest that, because of the low sensitivity and modest predictive value, the DDST may be relatively inefficient to use in a school entry screening program in a general community population of children.

Child, Preschool↗
PubMed1980

Tobacco use, occupation, coffee, various nutrients, and bladder cancer.

In a Canadian population-based case-control study of 480 males and 152 female case-control pairs, the relative risk for development of bladder cancer for ever used versus never used cigarettes was 3.9 for males and 2.4 for females, with a dose-response relationship in both sexes. A reduced risk was associated with the use of filter cigarettes compared to nonfilter cigarettes. After control for cigarette usage, a significant risk was noted for male pipe smokers. For male ex-smokers the risk after 15 years of no smoking was less than one-half that of current male smokers. Bladder cancer risk was found for workers in the chemical, rubber, photographic, petroleum, medical, and food processing industries among males and for workers occupationally exposed to dust or fumes among both sexes. Bladder cancer risk was elevated for males consuming all types of coffee, regular coffee, and instant coffee and for females consuming instant coffee, but no dose-response relationship was found. Risk was found for males consuming water from nonpublic supples but not for females. No risk was observed in males or females consuming nitrate-containing foods, beverages other than coffee, or fiddlehead greens. Hair dye usage in females and phenacetin usage in males and females carried no risk. Divergent findings by area for aspirin suggested that an overall association was not causal. Reevaluation of the data on artificial sweeteners confirmed a significant bladder cancer risk in males and a dose-response relationship. The cumulated population attributable risk for bladder cancer was 90% for males from cigarette smoking, industrial exposure, and exposure to nonpublic water supplies and 29% for females from cigarette smoking, industrial exposure, and instant coffee consumption.

Age Factors↗
PubMed1978

Quantitative assessment of the quality of medical care provided in five family practices before and after attachment of a family practice nurse.

The standards of patient care were maintained in five urban medical practices after the introduction of family practice nurses. Evaluations were achieved before and after their appointment by the indicator condition method. Minimal explicit criteria for the management of patients with 12 indicator conditions and by the use of 14 drugs were approved by an ad hoc peer group of community physicians. These cirteria were applied to the five practices by the use of a single-blind design and the abstraction of unaltered medical records. A standardized score for each practic e permitted comparison of scores for the management of indicator conditions and for the clinical use of drugs before and after attachment of the family practice nurses. For each of the indicator conditions and the drugs assessed in the five practices similar levels of adequacy were observed in the two study periods. These explicit (objective) audit resutls agreed with the implicit (subjective) assessments of the family practice nurses by their physician colleagues.

Drug Therapy↗
PubMed1978

The St John's randomized trial of the family practice nurse: health outcomes of patients.

From June 1975, to May 1976, in a large family practice in St. John's, Newfoundland, a randomized controlled trial was conducted to assess the effectiveness of a family practice nurse. Effectiveness was assessed using standardized health outcome measures of physical, emotional, and social function which could be applied easily and objectively by non-clinicians to the two groups of patients under study: patients receiving conventional care and patients receiving care from the family practice nurse. After establishing the comparability of these two groups of patients at the beginning of the study, these measurements showed similar levels of physical, emotional, and social function in the two groups after 1 year of receiving either family practice nurse or conventional care. These results agree with previous controlled trials of family practice nurses which have indicated that family practice nurses are effective and safe.

Adolescent↗
PubMed1977

Artificial sweeteners and human bladder cancer.

A positive association between the use of artificial sweetners, particularly saccharin, and risk of bladder cancer in males has been observed in a case-control study of 480 men and 152 women in three Provinces in Canada. The risk ratio for ever versus never used is 1-6 for males (P=0-009, one-tailed test), and a significant dose-response relationship was obtained for both duration and frequency of use. The population attributable risk for males is estimated at 7%, though for diabetics, who have a similar risk ratio for artificial sweetner use as non-diabetics, the attributable risk is 33%.

British Columbia↗
PubMed1977

A controlled trial of the impact of the family practice nurse on volume, quality, and cost of rural health services.

Rural Newfoundland communities with and without expanded role nurses were compared on a before and after basis. The rural communities are located in a geographically isolated area served by a 40-bed hospital staffed by salaried physicians. Primary care visits within the community increased by 186 per cent after establishment of the family practice nurse community clinic and attendance at the hospital decreased by 35 per cent. Acute care days in hospital decreased 5 per cent in the experimental group and increased by 39 per cent in the control group. A major portion of the community based visits provided to the experimental group were classed as preventive. The total annual health service cost per 1,000 persons in the experimental group increased slightly more than in the control group (26 versus 21 per cent). Adequate management of certain indicator conditions and drugs was maintained by the family practice nurse when compared to the adequacy rating for the physician during the same time period.

Community Health Nursing↗