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Biomedical subjects

N Beale

Publications and source records attributed to N Beale.

At least 19 recordsLinked to original sources
PubMed2001

Does Council Tax Valuation Band (CTVB) correlate with Under-Privileged Area 8 (UPA8) score and could it be a better 'Jarman Index'?

BACKGROUND: Widespread scepticism persists on the use of the Under-Privileged Area (UPA8) score of Jarman in distributing supplementary resources to so-attributed 'deprived' UK general practices. The search for better 'needs' markers continues. Having already shown that Council Tax Valuation Band (CTVB) is a predictor of UK GP workload, we compare, here, CTVB of residence of a random sample of patients with their respective 'Jarman' scores. METHODS: Correlation coefficient is calculated between (i) the CTVB of residence of a randomised sample of patients from an English general practice and (ii) the UPA8 scores of the relevant enumeration districts in which they live. RESULTS: There is a highly significant correlation between the two measures despite modest study size of 478 patients (85% response). CONCLUSIONS: The proposal that CTVB is a marker of deprivation and of clinical demand should be examined in more detail: it correlates with 'Jarman', which is already used in NHS resource allocation. But unlike 'Jarman', CTVB is simple, objective, and free of the problems of Census data. CTVB, being household-based, can be aggregated at will.

Catchment Area, Health↗
PubMed2001

Unequal to the task: deprivation, health and UK general practice at the millennium.

The NHS is over 50 years old, but health inequalities remain prevalent in the United Kingdom (UK). Material deprivation may be less apparent; however, social deprivation is becoming worse while the markers of socioeconomic disadvantage remain unsatisfactory. Health is an even more elusive concept; nevertheless, the evidence for an increasing association between deprivation, poor health, and early death is overwhelming. Equally unavoidable is the impact of this social degradation on UK primary care. Service industries have deserted deprived communities but, on the whole, GPs struggle on. Denied the supplementary resources they deserve they become disenchanted, too exhausted to convert incentives into rewards. Clear-headed strategic thinking from the top brass is overdue.

Cultural Deprivation↗
PubMed2000

Council tax valuation band as marker of deprivation and of general practice workload.

This study tests the hypothesis that Council Tax Valuation Banding (CTVB) is a measure both of UK socioeconomic status and of general practice workload. It is a retrospective cohort study based in a UK semi-rural general practice, North Wiltshire. The study group is a randomised selection of UK general practice patients. The outcome measures are socio-demographic and primary care workload parameters versus CTVBs by logistic regression analyses in a sample of 378 patients (90% participation rate). People who pay little or no council tax are significantly less likely to live in owner-occupied homes or to have access to a car than their counterparts. There is also a significant inverse association between CTVB and demand for general practitioner services. CTVB could be an accessible, universal, non-census marker of UK socioeconomic status and of general practice workload that would have validity in the context of primary care resource allocation and is a concept worthy of further investigation.

Cohort Studies↗
PubMed1994

Holiday travel and morbidity reported to general practitioners.

AIM: This study set out to explore the influence that holiday travel might have on the rate at which new episodes of illness are reported to general practitioners. METHOD: The study was carried out in a semi-rural practice of five doctors in Wiltshire in 1989. Details of patients' holiday travel were determined by postal questionnaire. Sociodemographic and clinical data were obtained from the patients' medical records. RESULTS: The response rate to the questionnaire was 85%. The study subjects were divided into those who had taken their holiday abroad (n = 643), those who had taken their holiday in the United Kingdom (n = 973), and those who had taken no holiday (n = 668) during the study year. Interim assessment of clinical results revealed no changes in morbidity indices in relation to holiday intervals in any of the groups except for an apparent rise in the number of new episodes of illness presented in the month before departure by those about to go abroad. Further analysis showed that this was due to a significant 112% increase in the number of episodes of illness presented by this study group in the week before they left home. CONCLUSION: This study suggests that the present focus on the supposed excess morbidity of patients returning from foreign holidays is misplaced.

Adolescent↗
PubMed1992

Poor Britain.

Explore the source record for details and available documents.

Health Status↗
PubMed1992

Use made by patients of chronic disease surveillance consultations in general practice.

A prospective, observational study of chronic disease surveillance consultations over a six-month period was performed in one semi-rural general practice in order to determine the content of the consultations, including incidental items not relevant to the chronic disease. At least one incidental item was recorded during 43% of consultations. There was substantial clinical content in these items: 23% of items required a prescription to be issued and 7% referral to a specialist. It is concluded that chronic disease surveillance consultations in general practice are frequently extended by patients who are anxious to discuss issues which may not be relevant to their chronic diseases. General practitioners must be sensitive to such patient expectations when they instigate chronic disease management clinics.

Adolescent↗
PubMed1991

Daily home visiting in one general practice: a longitudinal study of patient-initiated workload.

New requests for home visits performed by one general practitioner were recorded every weekday over 13 years from 1977 to 1989. Overall, a steady reduction in patient-initiated demand for visits was seen. However, longitudinal analysis by age showed that this was statistically significant only in patients aged under 65 years, for whom there was a 71% decrease. There was no significant change in the rates of visits requested for elderly (65-74 years old) and very elderly (75 years and over) patients. In the last year of the study 75% of daily visiting was requested by 18% of the patients, that is by the elderly and very elderly, a sector of the population which is increasing. The findings challenge the prediction that home visits will decline until they eventually disappear. General practitioners in the UK still need to maintain a domiciliary service to their elderly patients.

Adolescent↗
PubMed1988

Certificated sickness absence in industrial employees threatened with redundancy.

The proposition that workers take less sick leave when threatened by redundancy was examined in a longitudinal, controlled study using information from case records in a general practice. The hypothesis was only partly supported--certificated sickness absence dropped only in employees under the age of 40. Workers fearing job loss reported more illness, and their periods of absence were significantly longer, especially for men and for workers who had previously consulted their general practitioner infrequently. This study provides further evidence that the fear of mass redundancy is stressful to workers so threatened and costly to a society experiencing rising unemployment.

Absenteeism↗
PubMed1988

The nature of unemployment morbidity. 1. Recognition.

The case records of one group practice have been used as the data base for a longitudinal, controlled study of unemployment and health. Previous numerical analyses have shown increases in reported morbidity in families threatened with and experiencing unemployment. The illnesses reported have now been classified by diagnostic category. The illnesses normally most prevalant were presented less frequently when patients' jobs were insecure and lost, contradicting the suggestion that excess morbidity reported by the unemployed results only from lowered symptom tolerance. On reassembling the data according to the number of consultations per episode a genuine unemployment morbidity was indicated. After job loss among the male employees there was a significant increase in the number of episodes for which there were four or more consultations. It is postulated that unemployment leads to chronic ill health.

Adolescent↗
PubMed1988

The nature of unemployment morbidity. 2. Description.

A longitudinal, controlled study on job loss and health using general practice records has concluded that unemployment morbidity among men made redundant can be identified as an increase in those episodes of illness which are associated with many consultations. The possibility that these episodes represent chronic ill health has been tested using the same data base. If chronic illnesses are defined as those requiring active management after one year, their incidence among unemployed men was over six times that among controls (P<0.001). Cardiovascular disorders were frequently detected in the unemployed men and several of the other chronic complaints they suffered may also have had a psychosomatic aetiology related to stress. The consequent workload in terms of consultations, investigations, referrals, outpatient attendances and drug therapy increased significantly after job loss. More frequent, short-lived illnesses showed continuing downward trends in study and control men.The results suggest that unskilled men face a serious health hazard if made redundant. Investigating and treating their chronic disabilities leads to an increased medical workload and must further burden the health service.

Acute Disease↗
PubMed1987

[The health of industrial employees four years after compulsory redundancy].

A controlled, longitudinal study of the health of workers made redundant when a meat products factory closed has been performed using morbidity data extracted from the records of a group general practice. Increases in consultation rates and the number of visits to hospital outpatient departments in the group made redundant are contrasted with opposite trends in a control group who remained securely employed. As in earlier findings, the increases in morbidity in the study group began when they learned that their jobs were in jeopardy.The subsequent employment history of those made redundant was obtained by questionnaire. In the four years after redundancy, 50 of the 76 men in-the study group found new full-time jobs. The other 26 men remained out of work for most of this time or were made redundant once again. This 'jobless' group consulted their general practitioners 57% more often about 13% more illnesses, were referred to hospital outpatient departments 63% more often and visited hospital 208% more frequently than when enjoying secure employment. During an intervening two-year period of job insecurity, there were increases of 45%, 9%, 25% and 28% respectively, for this jobless group.The implications of these findings for primary care, for the National Health Service and for future research are discussed in the present context of high levels of unemployment.

England↗