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Biomedical subjects

P Coleman

Publications and source records attributed to P Coleman.

At least 73 records · Page 4Linked to original sources
PubMed1995

The epidemiology of sports and exercise related injury in the United Kingdom.

A national study of exercise related morbidity (ERM) in England and Wales was carried out using a postal questionnaire sent to 28,857 adults aged 16-45 years. The questionnaire asked about regular participation in sports or other recreational fitness activities involving physical exercise, and for details of any injuries occurring during a 28 d reference period. A return rate of 68% was achieved. Comparisons with other national data sources indicated that the information obtained was reliable. It is estimated that each year there are 29 million incidents resulting in new or recurrent injuries, however minor, of which 9.8 million (95% confidence interval 8.1 to 11.4 million) result in new 'substantive' injuries which are potentially serious, result in treatment, or in participants being unable to take part in their usual activities. Soccer accounted for more than 25% of all ERM, but the risk of a substantive injury in rugby was three times that in soccer. Over one third of ERM occurred in men aged 16-25 years. The most frequently reported injuries were sprains and strains of the lower limbs. Treatment was sought in approximately 25% of ERM incidents and 7% of all new ERM incidents involved attendance at a hospital accident and emergency department. The treatment provider most likely to be consulted was a general practitioner, but physiotherapists and complementary medicine practitioners were also consulted frequently. To maximize the health benefits of exercise, research strategies to reduce the volume and severity of ERM and to identify the most appropriate ways of managing ERM should be set.

Adolescent↗
PubMed1995

Can we prevent accidental injury to adolescents? A systematic review of the evidence.

OBJECTIVES: As part of the Department of Health strategy The Health of the Nation, a systematic review of published and unpublished literature relating to the effectiveness of interventions in reducing accidental injury in the population aged 15-24 years was carried out. METHODS: The literature was reviewed under the standard setting headings of road, work, home, and sports and leisure, and graded for quality of evidence and strength of recommendation using a scale published in the UK national epidemiologically based needs assessment programme. RESULTS: The most effective measures appear to be legislative and regulatory controls in road, sport, and workplace settings. Environmental engineering measures on the road and in sports have relatively low implementation costs and result in fewer injuries at all ages. There is little evidence that purely educational measures reduced injuries in the short term. Community based approaches may be effective in all age groups, and incentives to encourage safer behaviour hold promise but require further evaluation. The potential of multifactorial approaches seems greater than narrowly based linear approaches. CONCLUSIONS: Few interventions to reduce injury in adolescents have been rigorously evaluated using good quality randomised controlled trials, and where such evidence is available, fewer have been shown to be definitely worthwhile. Many studies relied on surrogate measures rather than actual injury rates, and substantial issues relating to the efficacy or implementation of preventive measures in adolescent and young adult populations remain unresolved.

Accident Prevention↗
PubMed1995

Assessing the outcome of making it easier for patients to change general practitioner: practice characteristics associated with patient movements.

BACKGROUND: The government white paper, Promoting better health, suggested that primary health care services should be made more responsive to patient needs and that competition, brought about by the freer movement of patients between practices, could act as a mechanism for improving the quality of the services provided. Policy changes reflecting these aims were introduced with the 1990 contract for general practitioners. AIM: A study was carried out to estimate the volume of patient movement between practices not attributable to a patient's change of address or to a major change in the practice they had left, and to investigate which practice characteristics patients moved towards and which they moved away from when changing general practitioner. METHOD: Data on 2617 patient movements during June 1991 were collected from five family health services authorities. These patient movements were analysed in relation to data on practice characteristics obtained from family health services authority records. RESULTS: The estimated volume of movement of patients between practices was small (1.6% of the registered population per year). The majority of movements were between group practices; a quarter of the movements recorded were to single-handed general practitioners. However, the ratio of the number of movements from group practices to single-handed general practitioners compared with those from single-handed general practitioners to group practices was 1.37 (95% confidence interval 1.19 to 1.57). In choosing single-handed general practitioners these patients were willing to forgo access to a woman general practitioner, extended services and greater hours of general practitioner availability. Among the subset of movements between group practices, patients were more likely to gain access to a practice nurse, longer surgery hours and a woman general practitioner as a consequence of their move. CONCLUSION: The scale of patient movement observed did not indicate any substantial mechanism by which the new policy of encouraging consumerist behaviour on the part of primary care users could effect desired changes in primary care practice. Among the patient movements observed, the evidence suggests that when choosing a practice potential patients were not deterred by the fact that a practice was single-handed. The public's perception of the factors contributing to a high quality of service may conflict with the official characterization of good practice and high quality services in primary health care.

Adolescent↗
PubMed1994

Hazardous waste worker education. Long-term effects.

This study illustrates how a union education center successfully integrated adult empowerment education principles into the teaching methods and curriculum of a health and safety training program. The 12-month follow-up phone survey involved 481 local union respondents each representing a separate plant site and a group of 50 manager trainees. The evaluation shows that the training manual continued to be used by more than 70% of respondents, more than 70% taught coworkers, more than 50% of union trainees went on to train their managers, and more than 90% identified problems at work and sought and obtained changes in programs, training, or equipment. More than 20% reported that major spills had occurred following training. The majority stated that the handling of the spills improved. More than 80% stated that the training better prepared them for their health and safety duties. The managers' data substantially supported union members' reports.

Accidents, Occupational↗
PubMed1994

Health and healthcare costs and benefits of exercise.

To assess the value of promoting health through exercise, we review what is known about the medical and medical care resource costs and benefits of exercise. Literature searches were undertaken to derive estimates of the relative risk, in individuals who exercise regularly compared with those who do not, of each of the major disease groups for which there is good evidence that the disease can be ameliorated by exercise (coronary heart disease, stroke, diabetes, hip fracture, and mental illness). These relative risks were used to estimate the incidence of hospital admissions and mortality, and associated healthcare costs, which could be prevented if the whole population exercised. Literature on the incidence and costs of exercise-related morbidity and mortality was also reviewed to derive estimates of both the costs to health and also the healthcare resource implications of exercise in total population. Indirect costs and benefits, and also quality-of-life effects associated with exercise were not included in this assessment. The results show that in younger adults (ages 15 to 44 years) the average annual medical care costs per person that might be incurred as a result of full participation in sport and exercise (approximately 30 pounds British sterling) exceed the costs that might be avoided by the disease-prevention effects of exercise ( less than 5 pounds British sterling per person). However, in older adults ( greater than or equal to 45) the estimated costs avoided ( greater than 30 pounds British sterling per person) greatly outweigh the costs that would be incurred ( less than 10 pounds British sterling). There was little evidence that exercise leads to deferred health or health service resource benefits. We conclude that with regard to health and medical care costs, there are strong economic arguments in favour of exercise in adults aged greater than or equal to 45 but not in younger adults. Estimates derived from the international scientific literature and routine UK data sources may have limited direct application in the healthcare systems of other countries. Nevertheless, the result that exercise costs exceed the benefits in younger adults but vice versa in older people is likely to be generally true. Indeed, a similar result has been found in a study of a Dutch population.

Adolescent↗
PubMed1993

Foods perceived by adults as causing adverse reactions.

This study was undertaken to identify differences in offending foods reported by 45 patients with classic symptoms of food allergy and/or subjective food-related complaints not traditionally associated with food allergy. On the basis of a comprehensive clinical history, skin testing, and double-blind food challenges, patients were diagnosed as having confirmed (n = 22) or unconfirmed (n = 23) adverse reactions to foods. The majority of patients in both groups were women-17 of those with confirmed reactions and 21 of those with unconfirmed reactions. Individuals with confirmed reactions were significantly younger, 34.8 +/- 10.9 years, than those with unconfirmed reactions, 41.5 +/- 9.6 years. The symptoms and reaction patterns of adults with confirmed reactions were generally consistent with immunoglobulin E-mediated food hypersensitivity. Individuals with unconfirmed reactions were more likely to report frequently occurring, delayed-onset symptoms of a nonspecific nature, and they had an average of five times as many foods causing adult-onset symptoms than those with confirmed reactions. Adults with confirmed reactions more often reported common food allergens such as tree nuts, legumes, and crustaceans; those with unconfirmed reactions were more apt to name foods not commonly implicated in adult food allergies confirmed by conventional diagnostic methods. The types of offending foods reported suggested that individuals with unconfirmed reactions were influenced by the popular news media and clinical ecology-oriented literature. Their use of nutrition supplements was consistent with the attitude of health activism. Such individuals may seek nontraditional health care or adopt questionable dietary practices. Individuals with adverse food reactions of a nonspecific nature pose challenging problems to dietitians.

Adult↗
PubMed1993

Overview of substance abuse.

Psychoactive substances have been used by humans from the earliest recorded times, and evidence shows that from the beginning some people have used drugs excessively, thus developing problems. From the 1960s to the 1980s, there has been a dramatic upswing in the use of alcohol and illicit substances, but some evidence demonstrates that this trend is beginning to reverse. Current substance abuse is estimated to cost US society about $152 billion and cause over 75,000 deaths annually. Research and treatment efforts have increased significantly over the past two decades. Although the exact cause of substance abuse disorders is unknown, evidence indicates that it is a complex interaction between biologic predispositions, and psychologic and social factors. The majority of research seems to indicate that at least in a subtype of patients with more severe abuse, genetic factors appear to be the single most important influence. Considerable research is underway to further clarify these factors, and it is reasonable to expect that we will soon have a much clearer understanding of the cause of these disorders. In turn, this understanding should lead to a better understanding of the optimal treatment for the millions of patients and families afflicted with substance abuse disorders.

Alcoholism↗