Biomedical subjects

Martin Blanchard

Publications and source records attributed to Martin Blanchard.

9 recordsLinked to original sources

PubMed2006

Estimating needs in life threatening illness: a feasibility study to assess the views of patients and doctors.

BACKGROUND: Provision of palliative care for patients with non-cancer conditions is hindered by the difficulty of predicting when people will die and fear of causing distress by raising end-of-life issues. OBJECTIVES: To compare patients' and professionals' (1) estimations of prognosis; (2) perceptions of the seriousness of the illness and needs for supportive care; and (3) acceptability of this sensitive research, in end-stage cancer and non-cancer diseases. DESIGN: Prospective cohort study. SETTING: A teaching hospital and a Marie Curie hospice in London. SUBJECTS: Twenty patients with advanced non-malignant disease (heart failure, chronic obstructive pulmonary disease and renal failure) and 20 patients with advanced cancer, and their physicians in charge. METHOD: A feasibility study using vignettes to aid patients and doctors estimate of prognoses. Main outcome measures were (1) patients' and physicians' estimates of health status, care needs and prognosis; and (2) patient survival. RESULTS: Patients were willing and able to estimate their own life expectancy and cancer patients correctly estimated that they had a poorer prognosis than non-cancer patients. Non-cancer patients perceived that they had similar needs for supportive care as cancer patients. Physicians made little distinction in palliative care needs between patients with and without cancer, but tended to make more pessimistic estimates of prognosis in non-cancer patients. CONCLUSIONS: Patients are able to judge their health status and life expectancy and do not object to questions about end-of-life care. Cancer and non-cancer patients have similar needs for supportive care. We need further evidence on the value of self-rated prognosis and how to provide palliative and supportive care for all patients who are near death.

Attitude of Health Personnel↗

PubMed2005

Deliberate self-harm (DSH) among older people: a retrospective study in Barnet, North London.

BACKGROUND: Rates of suicide remain high among older people and those who deliberately self harm are believed to be at an increased risk of killing themselves in the future. If older people who deliberately harm themselves are to be helped by developments in services we need to understand what currently happens to them in terms of service provision and outcome. METHODS: A retrospective paper and electronic case note survey was carried out on all older people living in the London Borough of Barnet who presented to Accident & Emergency Departments with DSH over a two-year period. Ensuing actions and events were then tracked. RESULTS: Forty-three older people with DSH were identified. 18/43 (42%) had previous contact with local psychiatric services. The main method of DSH was overdose of medication (36/43 or 84%). Compared to the general population there were more women and widows. There were similar levels of physical ill-health. Thirty-seven of 43 (86%) received documented psychiatric input outside of hospital following the DSH. The mean follow-up period was 789.0 days (SD 419.8) and during this time 8/43 (19%) had a further documented episode of DSH, and 18/43 (40%) died from natural causes. CONCLUSIONS: This study confirms the need for improved documentation of DSH and its coding; this needs to be reviewed at local and national level. The vast majority of older people who attempt suicide do have subsequent contact with psychiatric services. There is a strong likelihood of repeat DSH and a higher risk of death by natural causes, emphasising the need to conceptualise DSH as a risk factor relevant to all medical specialities.

Aged↗

PubMed2005

Psychotic symptoms in the general population of England--a comparison of ethnic groups (The EMPIRIC study).

BACKGROUND: There is considerable evidence that incidence of schizophrenia and other psychoses varies across ethnic groups in the UK, with particularly high rates for people of African-Caribbean origin. AIMS: The aims of this shady were to estimate in a community-based sample of people from ethnic minorities: 1) the prevalence of psychotic symptoms; and 2) risk factors for reporting psychotic symptoms. METHOD: Face-to-face interviews were carried out with a probabilistic sample of 4281 adults from six ethnic groups living in the UK. Psychotic symptoms were measured using the psychosis screening questionnaire (PSQ). RESULTS: There was a twofold higher rate of reporting psychotic symptoms on the PSQ in Black Caribbean people compared with Whites. Adjustment for demographic factors had little effect on this association. CONCLUSION: Prevalence rates of psychotic symptoms were higher in people from ethnic minorities, but were not consistent with the much higher first contact rates for psychotic disorder reported previously, particularly in Black Caribbeans.

Adolescent↗

PubMed2005

The development of a questionnaire to assess the attitudes of older people to end-of-life issues (AEOLI).

OBJECTIVES: To develop an end-of-life attitudes questionnaire for use in a large community-based sample of older people. DESIGN: Nominal groups and standardization of questions. PARTICIPANTS: Eighteen older people, ten academics and five specialist palliative care health professionals were involved in nominal groups. Thirty older people took part in initial pilot work and a further 50 were involved in reliability testing. RESULTS: A 27-item attitudes of older people to end-of-life issues (AEOLI) questionnaire. DISCUSSION: In modern times, death and dying predominantly occurs among older people and yet we know very little about older people's attitudes to end-of-life care. The AEOLI questionnaire can be used in large scale surveys to elicit attitudes on end-of life issues considered important by older people and health care professionals.

Aged↗

PubMed2005

Older adults' attitudes to death, palliative treatment and hospice care.

BACKGROUND: Cancer patients who receive care from specialist palliative care services in the UK are younger than those who do not receive this care. This may be explained by age-related differences in attitudes to end-of-life care. OBJECTIVE: To determine the relationship between age and i) attitudes to death and preparation for death; and ii) knowledge about, and attitudes to, cancer and palliative care. DESIGN: Interviews with older people, using a novel questionnaire developed using nominal groups. Main comparisons were made between people aged 55-74 with those aged 75 years and over. SETTING: General practices in London. SUBJECTS: 129 people aged 55-74 and 127 people aged 75 years or over on the lists of general practitioners. METHODS: A cross-sectional survey to determine knowledge and experience of hospice care; preparation for end-of-life; and attitudes to end-of-life issues. RESULTS: Participants were knowledgeable about specialist palliative care and almost half had some indirect contact with a hospice. People aged >74 were less likely than younger participants to want their doctor to end their life in a terminal illness. Although they believed death was easier to face for older people, they did not believe that younger people deserved more consideration than older people when dying, or that they should have priority for hospice care. Education, social class, hospice knowledge and anxiety about death had little influence on overall attitudes. CONCLUSIONS: The relative under-utilization of hospice and specialist palliative care services by older people with cancer in the UK cannot be explained by their attitudes to end-of-life issues and palliative care.

Age Factors↗

PubMed2004

Common mental disorders and ethnicity in England: the EMPIRIC study.

BACKGROUND: There is little population-based evidence on ethnic variation in the most common mental disorders (CMD), anxiety and depression. We compared the prevalence of CMD among representative samples of White, Irish, Black Caribbean, Bangladeshi, Indian and Pakistani individuals living in England using a standardized clinical interview. METHOD: Cross-sectional survey of 4281 adults aged 16-74 years living in private households in England. CMD were assessed using the Revised Clinical Interview Schedule (CIS-R), a standardized clinical interview. RESULTS: Ethnic differences in the prevalence of CMD were modest, and some variation with age and sex was noted. Compared to White counterparts, the prevalence of CMD was higher to a statistically significant degree among Irish [adjusted rate ratios (RR) 2.09, 95% CI 1.16-2.95, p = 0.02] and Pakistani (adjusted RR 2.38, 95 % CI 1.25-3.53, p = 0.02) men aged 35-54 years, even after adjusting for differences in socio-economic status. Higher rates of CMD were also observed among Indian and Pakistani women aged 55-74 years, compared to White women of similar age. The prevalence of CMD among Bangladeshi women was lower than among White women, although this was restricted to those not interviewed in English. There were no differences in rates between Black Caribbean and White samples. CONCLUSIONS: Middle-aged Irish and Pakistani men, and older Indian and Pakistani women, had significantly higher rates of CMD than their White counterparts. The very low prevalence of CMD among Bangladeshi women contrasted with high levels of socio-economic deprivation among this group. Further study is needed to explore reasons for this variation.

Adolescent↗

PubMed2004

Older people with depression: pilot study.

BACKGROUND: Although a substantial number of studies have identified the prevalence of depression experienced by older adults living in the community and the factors that may precipitate this depression, few have focussed on depression in older people who attend day centres. Consequently, there is no literature suggesting how depression in this population may be psychologically managed. AIMS: The aim of this paper is to present the results of a pilot study investigating the incidence of depression in people attending a London Age Concern day centre, and its associations with perceptions of handicap, loneliness, social support networks, satisfaction with social support, and satisfaction with life. METHODS: A quasi-experimental, cross-sectional pilot study was conducted with attendees at a London Age Concern day centre between November 1998 and January 1999. The day centre manager selected a convenience sample of 24 of 156 participants. Inclusion criteria were that participants must attend the day centre regularly and be over or equal to 65 years of age. The exclusion criterion was known psychiatric illness. Participants were interviewed using the Geriatric Mental State-Automated Geriatric Examination for Computer Assisted Taxonomy, which identifies caseness of psychopathology and includes a loneliness subscale, and completed the Satisfaction with Life Scale, Social Support Questionnaire and London Handicap Scale. RESULTS: There was a higher level of depression in this day centre setting than that found in other community-based studies. There were the expected significant associations between depression and loneliness, and depression and satisfaction with life. However, unexpectedly, there were no associations between depression and social support, or depression and handicap. CONCLUSIONS: The study has several limitations. However, the high level of depression and significant relationships between depression, loneliness and satisfaction with life may indicate that the social function of day centres is not meeting expectations. This suggests that there could be a role for community mental health nurses in offering psychosocial interventions to alleviate some of the distress experienced.

Aged↗

PubMed2002

Mental health and the built environment: cross-sectional survey of individual and contextual risk factors for depression.

BACKGROUND: Little is known about the effects of the physical environment on individual health. AIMS: The present study tested the hypothesis that the prevalence of depression is associated with independently rated measures of the built environment, after adjusting for individuals' socio-economic status and the internal characteristics of their dwellings. METHOD: Cross-sectional survey of 1887 individuals aged 16 years and over in two electoral wards in north London. Depression was ascertained using the Center for Epidemiologic Studies Depression scale (CES-D). The built environment was rated independently, using a validated measure. RESULTS: After adjusting for socio-economic status, floor of residence and structural housing problems, statistically significant associations were found between the prevalence of depression and living in housing areas characterised by properties with predominantly deck access (odds ratio=1.28, 95% CI 1.03-1.58; P=0.02) and of recent (post-1969) construction (odds ratio=1.43, 95% CI 1.06-1.91; P=0.02). CONCLUSIONS: The prevalence of depression was associated with independently rated features of the built environment, independent of individuals' socio-economic status and internal characteristics of dwellings.

Adolescent↗

PubMed2002

Applying community-oriented primary care methods in British general practice: a case study.

BACKGROUND: The '75 and over' assessments built into the 1990 contract for general practice have failed to enthuse primary care teams or make a significant impact on the health of older people. Alternative methods for improving the health of older people living at home are being sought. AIM: To test the feasibility of applying community-oriented primary care methodology to a relatively deprived sub-population of older people in a relatively deprived area. DESIGN OF STUDY: A combination of developmental and triangulation approaches to data analysis. SETTING: Four general practices in an inner London borough. METHOD: A community-oriented primary care approach was used to initiate innovative care for older people, supported financially by the health authority and practically by primary care academics. RESULTS: All four practices identified problems needing attention in the older population, developed different projects focused on particular needs among older people, and tested them in practice. Patient and public involvement were central to the design and implementation processes in only one practice. Innovations were sustained in only one practice, but some were adopted by a primary care group and others extended to a wider group of practices by the health authority. CONCLUSION: A modified community-oriented primary care approach can be used in British general practice, and changes can be promoted that are perceived as valuable by planning bodies. However, this methodology may have more impact at primary care trust level than at practice level.

Aged↗