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Biomedical subjects

S Ebrahim

Publications and source records attributed to S Ebrahim.

At least 163 records · Page 9Linked to original sources
PubMed1998

The prevalence of diagnoses, impairments, disabilities and handicaps in a population of elderly people living in a defined geographical area: the Gospel Oak project.

OBJECTIVE: to measure the prevalence of impairments, disabilities and handicaps in a geographically-defined elderly population. DESIGN: cross-sectional analysis of an interview survey. SETTING: a single North London electoral ward (district). PARTICIPANTS: 654 residents (74%) over the age of 65 years were interviewed from a register of 889. A random sample of 225 had additional data collected which are reported in this analysis. MAIN OUTCOME MEASURES: point prevalence and distribution of the total number of reported diagnoses, impairments and disabilities, and distributions of the Office of Population Censuses and Surveys (OPCS) disability scale and the London Handicap Scale scores. RESULTS: participants had a median of three reported diagnoses and two impairments. Forty-three percent were in the least disabled OPCS disability category (i.e. below the disability threshold) and 41% were able to undertake all of 12 basic activities of daily living without difficulty. Overall handicap scores were heavily skewed towards no health-related disadvantage, with a median score of 83 out of 100, and 37% having a score of 90 or more. All indicators showed deteriorating health with increasing age, but age-adjusted gender differences were small. CONCLUSIONS: an elderly population's health problems were classified using a comprehensive framework, revealing high prevalences of diagnoses, impairments, disabilities and handicaps. The schema is appropriate for health care needs assessment and is a suitable basis for describing the population's health.

Aged↗
PubMed1998

Associations between diagnoses, impairments, disability and handicap in a population of elderly people.

BACKGROUND: 'Handicap' is the disadvantage for an individual that results from ill-health. It represents an important outcome in chronic disabling disease, but has proved difficult to measure until recently. The strength of association between handicap and other health status measures, and the relative contributions of health and socioeconomic variables to handicap have not been studied previously. METHODS: We undertook a cross-sectional survey of all people > 65 years old in a defined geographical area of North London. The interview was based on the short-CARE psychiatric survey tool, and in addition included measures of physical health and disability, the London Handicap Scale, income, social support and housing. In all, 654 residents (74%) from a register of 889 were interviewed. A random sample of 225 had additional data collected which are reported in this analysis. RESULTS: Strength of association with handicap scores increased progressively from diagnosis to impairment to disability. Variation in handicap with diagnosis was explained by impairment, and variation with impairment was mostly explained by disability. Age, housing quality, social support and income were associated with handicap score, but confounding by these did not explain the association between handicap and other aspects of disablement. Disease-associated variables explained quantitatively much more variation in handicap than socioeconomic variables. CONCLUSIONS: The most potent influences on handicap are disease and disability, justifying the high priority given by health services to detection, treatment and rehabilitation. Where this is not possible handicap may be reduced to some extent through socioeconomic intervention.

Aged↗
PubMed1998

Lowering blood pressure: a systematic review of sustained effects of non-pharmacological interventions.

BACKGROUND: Risk factors for raised blood pressure include obesity, physical inactivity, high dietary salt intake, stress, and high alcohol consumption. Much less is known about the effects on blood pressure of modification of these risk factors for the purposes of disease prevention. A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to estimate the effects of various non-pharmacological interventions on blood pressure. METHODS: RCTs of single interventions aimed at altering these risk factors among adults aged 45 or older with and without hypertension, and with at least six months follow-up were included. MEDLINE was the primary source and the boundaries of the study were from 1966 to April 1995. RESULTS: The majority of RCTs were of short duration and did not provide guidance on the sustainability of effects and were excluded. Totals of eight RCTs of salt restriction, eight RCTs of weight reduction, eight of stress management, eight of exercise, and one of alcohol reduction of longer than six months duration were found. Net (i.e. intervention - control group) systolic blood pressure changes, mean mm Hg (with 95 per cent confidence intervals in parentheses), in hypertensives were as follows: salt restriction -2.9 (-5.8,0.0), weight loss -5.2 (-8.3,-2.0), stress control -1.0 (-2.3,+0.3), and exercise -0.8 (-5.9,+4.2). Smaller changes were found in normotensive participants: salt restriction -1.3 (-2.7,+0.1), weight loss -2.8 (-3.9,-1.8), exercise -0.2 (-2.8,+2.4), and alcohol reduction -2.1 (-4.1,-0.1). Some interventions (e.g. stress control in normotensives) were not examined in either hypertensives or normotensives. The majority of RCTs were of low methodological quality and bias often tended to increase the changes observed. Few of the trials controlled for the confounding effects of concurrent changes in other blood pressure risk factors. CONCLUSION: These net changes are probably overestimates of the effects that might be achieved by non-pharmacological interventions. There is a need for large-scale, long duration trials of these non-pharmacological interventions in both hypertensive patients and normotensive people to determine effect sizes more accurately.

Adult↗
PubMed1998

The effect of zinc and vitamin A supplementation on immune response in an older population.

OBJECTIVE: To determine if either supplemental vitamin A, zinc, or both increases cell-mediated immune response in an older population. DESIGN: A double-blind, randomized, controlled trial of supplementation with vitamin A and zinc. SETTING: Casa Di Riposo Roma III, a public home for older people in Rome, Italy. SUBJECTS: The health and nutritional status of 178 residents were evaluated. One hundred thirty-six residents agreed to participate in the trial and were randomized into four treatment groups, and 118 of these residents completed the trial. INTERVENTION: The four treatments consisted of: (1) Vitamin A (800 micrograms retinol palmitate); (2) Zinc (25 mg as zinc sulfate); (3) Vitamin A and Zinc (800 micrograms retinol palmitate and 25 mg as zinc sulfate); (4) Placebo capsules containing starch. MAIN OUTCOME MEASUREMENTS: Immune tests-counts of leucocytes, lymphocytes, T-cell subsets, and lymphocyte proliferative response to mitogens-were measured before and after supplementation. RESULTS: Zinc increased the number of CD4 + DR + T-cells (P = .016) and cytotoxic T-lymphocytes (P = .005). Subjects treated with vitamin A experienced a reduction in the number of CD3 + T-cells (P = .012) and CD4 + T-cells (P = .012). CONCLUSIONS: These data indicate that zinc supplementation improved cell-mediated immune response, whereas vitamin A had a deleterious effect in this older population. Further research is needed to clarify the clinical significance of these findings.

Aged↗
PubMed1998

The views of therapists on the use of a patient-held record in the care of stroke patients.

OBJECTIVE: To explore the views of therapists working with stroke patients on the use of a patient-held record (PHR) for stroke patients. A PHR was developed in the form of a pocket-sized booklet (21 cm x 14.5 cm) in which staff recorded information relating to the patient's management. The aim of the PHR was to facilitate communication and involve patients more directly in their care. METHODS: Six semi-structured group interviews were conducted with therapists (25 in total) from one inner city hospital. RESULTS: The following themes emerged from the content analysis: (1) Therapists were supportive of plans for a PHR, citing the benefits of greater patient involvement. (2) However, they questioned its feasibility, in particular the issue of patient responsibility and its use with the cognitively impaired. (3) They also questioned its ability to facilitate communication among health professionals because of existing differences in perspectives. (4) These therapists revealed concerns about the effect that information may have on patients. (5) They also raised practical issues about finding the time to make entries, wording and content of entries in the PHR. CONCLUSION: Responsibility for the PHR may enhance patients' understanding and involvement in their care, yet ownership alone does not guarantee the confidence needed to encourage dialogue between patients and care providers. Furthermore, it is doubtful whether a PHR can hope to overcome the fundamental differences in the philosophies of care which the therapists reported.

Aged↗
PubMed1998

A patient-centred study of the consequences of stroke.

OBJECTIVE: To explore subjective accounts of the consequences of stroke. DESIGN: Qualitative methods using depth interviews. PARTICIPANTS AND SETTING: Forty people sampled ten months post stroke from a hospital stroke register which was established in two adjacent health districts in North Thames Regional Health Authority. RESULTS: Interviewees reported a number of ways in which the stroke had affected their daily lives, including difficulty with leaving the house, doing the housework, pursuing former leisure activities, inability to walk in the way they wanted, problems with communicating, washing, bathing and dressing, and with confusion and deteriorating memory. In all these areas people described the loss of social contact that accompanied these changes, and the loss of valued roles which had been embedded in the everyday functions they had previously performed. In general, people over the age of 70 were more seriously affected. CONCLUSION: The type of changes which people reported would not easily have been captured using standardized outcome measures, pointing to the value of qualitative methods in providing subjective accounts. In terms of clinical practice, there is a need to reduce people's isolation after stroke by providing home visits after discharge, particularly to those living alone, and also by reducing disability through rehabilitation and by tackling the environmental obstacles which can imprison people in their homes. The findings suggest that many people with stroke would benefit from being able to talk about the changes which have occurred. Imaginative proposals are needed to develop ways to help replace the loss of activities, social contacts and social roles, particularly among older people with stroke.

Activities of Daily Living↗
PubMed1998

A profile of hypertension among rural elderly Malaysians.

The main objective of this study was to survey the prevalence of hypertension in Malaysians aged 55 years and above who responded to a public health screening campaign in Kuala Langat district, Selangor, Malaysia. The relationship between the detection, treatment and control in the study population was also examined. An epidemiological survey of the elderly was conducted in Kuala Langat, a rural district in Malaysia for a consecutive period of six weeks. The survey was conducted using a standardized questionnaire and interview by trained research assistants. The medical students and nurses were trained on the correct protocol of measuring blood pressure based on the recommendations of the British Hypertension Society. Newly detected persons with blood pressure readings 160/95 mmHg and above, were given a green card to return to the nearest health center for a further 2 visits to check his/her blood pressure. A total of 1,392 people with a mean age of 65 years and comprising of 53.1% males and 46.9% females responded to the health survey. Based on the history 335 (24.1%) of the respondents were known hypertensives and 82.1% of this hypertensive group were on regular treatment. However good control of hypertension was achieved only in 161 (48.1%) of them. Newly detected hypertension was found in 204 (14.6%) of the respondents. The overall prevalence of hypertension in our sample of respondents was 25.6%. There was no significant difference between the sexes and the races in terms of their detection, treatment and control. However there was a significant difference between the persons aged less than 65 years of age and those older than 65 years. There was a large proportion of previously known hypertensives among the survey population. Of those detected, not all were on regular medications and the majority on medications were not well controlled. Education of the public through intensive public health campaigns is vital to improve their knowledge on hypertension and the need for effective control. More community studies are needed to formulate better methods in the detection, treatment and control of hypertension.

Age Distribution↗
PubMed1998

Effectiveness and cost analysis of community-based rehabilitation service in Bangkok.

This paper aimed to clarify the effectiveness and the cost of the community-based rehabilitation service in Klong Toey slum after a three year study period. One hundred and seventy eight patients used community-based rehabilitation during the three year period. One hundred and fifty-seven patients (86.5%) reported that their problems/conditions were cured or improved. Only nine patients (5.1%) reported that they stopped using community-based rehabilitation because their problems/conditions did not improve. A statistically significant improvement in pain level and walking velocity assessment, in 105 and 78 patients respectively, was demonstrated. Total cost and cost per patient-day of the community-based rehabilitation were Bt 559,920 and Bt 111.1 respectively. Cost per-patient-day of this community-based rehabilitation service was compared with an estimated cost per patient-day of using rehabilitation services at Chulalongkorn University Hospital and was found to be cheaper. This study supported the role of community-based rehabilitation in Thailand. The need for a health service study in rural areas was also noted.

Cost-Benefit Analysis↗
PubMed1997

Systematic review of randomised controlled trials of multiple risk factor interventions for preventing coronary heart disease.

OBJECTIVE: To assess the effectiveness of multiple risk factor intervention in reducing cardiovascular risk factors, total mortality, and mortality from coronary heart disease among adults. DESIGN: Systematic review and meta-analysis of randomised controlled trials in workforces and in primary care in which subjects were randomly allocated to more than one of six interventions (stopping smoking, exercise, dietary advice, weight control, antihypertensive drugs, and cholesterol lowering drugs) and followed up for at least six months. SUBJECTS: Adults aged 17-73 years, 903000 person years of observation were included in nine trials with clinical event outcomes and 303000 person years in five trials with risk factor outcomes alone. MAIN OUTCOME MEASURES: Changes in systolic and diastolic blood pressure, smoking rates, blood cholesterol concentrations, total mortality, and mortality from coronary heart disease. RESULTS: Net decreases in systolic and diastolic blood pressure, smoking prevalence, and blood cholesterol were 4.2 mm Hg (SE 0.19 mm Hg), 2.7 mm Hg (0.09 mm Hg), 4.2% (0.3%), and 0.14 mmol/l (0.01 mmol/l) respectively. In the nine trials with clinical event end points the pooled odds ratios for total and coronary heart disease mortality were 0.97 (95% confidence interval 0.92 to 1.02) and 0.96 (0.88 to 1.04) respectively. Statistical heterogeneity between the studies with respect to changes in mortality and risk factors was due to trials focusing on hypertensive participants and those using considerable amounts of drug treatment, with only these trials showing significant reductions in mortality. CONCLUSIONS: The pooled effects of multiple risk factor intervention on mortality were insignificant and a small, but potentially important, benefit of treatment (about a 10% reduction in mortality) may have been missed. Changes in risk factors were modest, were related to the amount of pharmacological treatment used, and in some cases may have been overestimated because of regression to the mean, lack of intention to treat analyses, habituation to blood pressure measurement, and use of self reports of smoking. Interventions using personal or family counselling and education with or without pharmacological treatments seem to be more effective at reducing risk factors and therefore mortality in high risk hypertensive populations. The evidence suggests that such interventions implemented through standard health education methods have limited use in the general population. Health protection through fiscal and legislative measure may be more effective.

Adolescent↗
PubMed1997

Redefining 'doing something': health professionals' views on their role in the care of stroke patients.

Stroke has traditionally been considered, both by lay people and by many people working within the health services, to be a tragic yet essentially uninteresting condition, possibly because of its associations with old age, chronicity and the widespread perception that very little can be done about it. This study explored health professionals' views about their role in caring for people with stroke, and about what they gained from and contributed to this work. Questionnaires were distributed to staff working on an elderly care unit, a general medical ward and a stroke unit. Nurses and physiotherapists were positive and reported that they had much to offer people with stroke, and many rewards to gain from their work. Occupational therapists reported that in theory they had much to contribute to people with stroke, but in practice lack of resources and staff shortages prevented them from fulfilling their potential. Speech therapists also complained of scarce resources, and of a lack of recognition of their specialty, but felt able to contribute to improving peoples' quality of life. Both psychologists reported that their work with people with stroke was satisfying and stimulating. However, with the exception of the consultant on the stroke unit, doctors reported feeling they had little to offer, and little to gain from working with people with stroke. Therapists on the elderly care unit, and speech therapists in all settings reported difficulties within the multidisciplinary team. Although each profession had different concerns and priorities, the majority seemed to have a positive approach to their work with people with stroke. Similarly, the majority reported that the best thing about their work was when people recovered, although professions defined recovery differently.

Aged↗
PubMed1997

Zinc supplementation and plasma lipid peroxides in an elderly population.

OBJECTIVE: To determine the effect of vitamin A, zinc or both on plasma lipid peroxides in a healthy elderly population. DESIGN: Double-blind randomized controlled trial supplementation of vitamin A and zinc. SETTING: Public home for elderly people, in Rome, Italy. SUBJECTS: A total of 178 residents of a Public home for elderly people were evaluated regarding health and nutritional status. 136 gave a written consensus to participate in the trial and were randomized in four groups of treatment. 118 elderly completed the trial. INTERVENTIONS: Three months supplementation of the following treatments: (1) vitamin A (800 micrograms retinol palmitate); (2) zinc (25 mg zinc as sulphate); (3) vitamin A and zinc (800 micrograms retinol palmitate and 25 mg zinc as sulphate); (4) placebo (starch containing capsules). MAIN OUTCOME MEASURES: Plasma lipid peroxides (TBA-RS) were measured before and after supplementation. RESULTS: Zinc supplementation was associated with a decrease in plasma lipid peroxides (beta = -0.19; 95% confidence levels: -0.37, -0.002; p-value = 0.05) after adjusting for sex, smoking habits, baseline plasma lipid peroxides and vitamin A plasma levels. CONCLUSIONS: Zinc supplementation decreased plasma lipid peroxides while vitamin A had no effect in this elderly population. Adequate zinc intake or supplementation could play an important role in the prevention and/ or modulation of diseases in the elderly people.

Aged↗
PubMed1997

Identification and management of stroke risk in older people: a national survey of current practice in primary care.

The current practice of stroke prevention was assessed among UK general practitioners (GPs) using a postal questionnaire. A random sample of 583 GPs (response rate 60%) in practice throughout the UK was examined. Main outcomes were the reported practice in the identification of stroke risk, management of hypertension, and use of other interventions (particularly aspirin treatment) to reduce the risk of stroke. Most respondents (451, 77%) reported that they specifically identified patients at high risk of stroke. However, of these only 301 (67%) used more than one major risk factor to do this and less than one-third used either age or pre-existing cardiovascular disease as an indicator. Thresholds for drug treatment of hypertension increased markedly with patient age with only 68%, 23% and 9% of respondents reporting treating elevated systolic, diastolic and isolated systolic pressures respectively, in accord with the British Hypertension Society (BHS) guidelines for patients aged 70-79 years. Thresholds for blood pressure (BP) treatment in older patients did not differ by region but were higher among respondents who had been in general practice for more than 10 years. The value of aspirin in preventing stroke in patients with pre-existing cardiovascular disease was recognized by almost all (560, 96%) respondents. The results suggest that there is scope for increasing the benefits of stroke prevention in primary care, by focusing on the management of patients at high absolute risk, in whom the greatest treatment benefits are likely to be obtained.

Aged↗
PubMed1997

Randomized placebo-controlled trial of brisk walking in the prevention of postmenopausal osteoporosis.

OBJECTIVE: to evaluate the effects of brisk walking on bone mineral density in women who had suffered an upper limb fracture. DESIGN: randomized placebo-controlled trial. Assessments of bone mineral density were made before and at 1 and 2 years after intervention. Standardized and validated measures of physical capacity, self-rated health status and falls were used. SETTING: district general hospital outpatient department. SUBJECTS: 165 women drawn from local accident and emergency departments with a history of fracture of an upper limb in the previous 2 years. Women were randomly allocated to intervention (self-paced brisk walking) or placebo (upper limb exercises) groups. INTERVENTION: both groups were seen at 3-monthly intervals to assess progress, measure physical capacity and maintain enthusiasm. The brisk-walking group were instructed to progressively increase the amount and speed of walking in a manner that suited them. The upper limb exercise placebo group were asked to carry out a series of exercises designed to improve flexibility and fine hand movements, appropriate for a past history of upper limb fracture. RESULTS: drop-outs from both intervention and placebo groups were substantial (41%), although there were no significant differences in bone mineral density, physical capacity or health status between drop-outs and participants. At 2 years, among those completing the trial, bone mineral density at the femoral neck had fallen in the placebo group to a greater extent than in the brisk-walking group [mean net difference between intervention and placebo groups 0.019 g/cm2, 95% confidence interval (CI) -0.0026 to +0.041 g/cm2, P = 0.056]. Lumbar spine bone mineral density had increased to a similar extent (+0.017 g/cm2) in both groups. The cumulative risk of falls was higher in the brisk-walking group (excess risk of 15 per 100 person-years, 95% CI 1.4-29 per 100 person-years, P < 0.05). There were no significant differences in clinical or spinal x-ray fracture risk or self-rated health status between intervention and placebo groups. CONCLUSION: the promotion of exercise through brisk-walking advice given by nursing staff may have a small, but clinically important, impact on bone mineral density but is associated with an increased risk of falls. Self-paced brisk walking is difficult to evaluate in randomized controlled trials because of drop-outs, placebo group exercise, limited compliance and lack of standardization of the duration and intensity of walking. Further work is needed to evaluate the best means of safely achieving increased activity levels in different groups, such as older women and those at high risk of fractures.

Accidental Falls↗