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Biomedical subjects

S J Gillam

Publications and source records attributed to S J Gillam.

16 recordsLinked to original sources
PubMed1995

Children discharged following nutritional rehabilitation: a follow-up study.

The results of a 1-year follow up of children discharged from a nutritional rehabilitation centre (NRC) in eastern Nepal are presented. One hundred and one children were visited at home on discharge from the NRC, at 6 months and 1 year later. Data were collected concurrently on one sibling and two neighbouring children matched for age and sex. Anthropometry was carried out at each visit and information collected on socio-economic variables and child feeding practices. A significantly higher death rate was observed in index children as compared with controls. Index children demonstrated catch-up growth with both greater weight gain and faster increases in height than either control group post-discharge. At 6 months, mean weight-for-height was similar in all three groups but at one year mean height-for-age was still lower in the index children as compared with controls. The prognosis for female children appeared to be poorer than for boys.

Case-Control Studies↗
PubMed1995

Investigation of benefits and costs of an ophthalmic outreach clinic in general practice.

BACKGROUND: With the advent of general practitioner fundholding, there has been growth in outreach clinics covering many specialties. The benefits and costs of this model of service provision are unclear. AIM: A pilot study aimed to evaluate an outreach model of ophthalmic care in terms of its impact on general practitioners, their use of secondary ophthalmology services, patients' views, and costs. METHOD: A prospective study, from April 1992 to March 1993, of the introduction of an ophthalmic outreach service in 17 general practices in London was undertaken. An ophthalmic outreach team, comprising an ophthalmic medical practitioner and an ophthalmic nurse, held clinics in the practices once a month. Referral rates to Edgware General Hospital ophthalmology outpatient department over one year from the study practices were compared with those from 17 control practices. General practitioners' assessments of the scheme and its impact on their knowledge and practice of ophthalmology were sought through a postal survey of all partners and interviews with one partner in each practice. Patient surveys were conducted using self-administered structured questionnaires. A costings exercise compared the outreach model with the conventional hospital ophthalmology outpatient clinic. RESULTS: Of 1309 patients seen by the outreach team in the study practices, 480 (37%) were referred to the ophthalmology outpatient department. The annual referral rate to this department from control practices was 9.5 per 10,000 registered patients compared with 3.8 per 10,000 registered patients from study practices. A total of 1187 patients were referred to the outpatient department from control practices. An increase in knowledge of ophthalmology was reported by 18 of 47 general practitioners (38%). Nineteen (40%) of 47 general practitioners took advantage of the opportunity for inservice training with the outreach team; they were more likely to change their routine practice for ophthalmic care or referral criteria for patients with cataracts or diabetes than those who did not attend for inservice training. The outreach scheme was popular with patients, for whom ease of access and familiarity of surroundings were major advantages. The cost per patient seen in the outreach clinics (48.09 pounds) was about three times the cost per patient seen in the outpatient department (15.71 pounds). CONCLUSION: The model of ophthalmic outreach care in this pilot study was popular with patients and general practitioners and appeared to act as an effective filter of demand for care in the hospital setting. However, the educational impact of the scheme was limited. Although the unit costs (per patient) of the outreach scheme compared unfavourably with those of conventional outpatient treatment, potential health gains from this more accessible model of care require further exploration.

Ambulatory Care Facilities↗
PubMed1992

Vaccine coverage: recent trends and future prospects.

OBJECTIVE: To assess the feasibility of achieving the target of 95% coverage for the childhood immunisation schedule by 1995 and to determine the influence of sociodemographic factors and information systems on recent trends. DESIGN: Analyses of trends in quarterly vaccination data for diphtheria, pertussis, and measles in health districts between February 1988 and February 1991. SETTING: District health authorities in England and Wales, and health and social services boards in Northern Ireland. SUBJECTS: Cohorts of children whose youngest member had reached the target age of 18 months for receiving the third doses of diphtheria and pertussis vaccines and 2 years for receiving measles vaccine. RESULTS: Predicted coverage levels for mid-1995 were in excess of 95% for diphtheria, pertussis, and measles vaccines. In the 118 districts that continuously reported between February 1988 and February 1991 the increase in coverage was 6% for diphtheria and 13% for pertussis and measles vaccines. 1991 coverage depended primarily on 1988 coverage. The additional effects of deprivation, change in computer system, and child population size achieved at most only marginal statistical significance. CONCLUSIONS: The government's target of 95% coverage by 1995 is realistic, although projections should be viewed with caution. Several national vaccination initiatives are likely to have contributed to the recent steady increase in coverage. Updating and validation exercises are likely to improve recorded coverage.

Child, Preschool↗
PubMed1992

Provision of health promotion clinics in relation to population need: another example of the inverse care law?

The new contract encourages health promotion in general practice. The aim of this study was to explore the pattern of provision of health promotion clinics across one family health services authority and to relate this to possible indicators of health need in the practice population. Single-handed practices were less likely to be running health promotion clinics. The proportion of practices running clinics increased with increasing numbers of partners. Practices located in wards where the standardized mortality ratio was greater than 100, and practices receiving deprivation payments were less likely to be offering health promotion clinics. This was explained by the presence of most single-handed practitioners in deprived, historically unhealthy wards. If effective, health promotion clinics will have tended to benefit populations in Bedfordshire at lower risk of ill-health. Other shortcomings of the clinic-based health promotion model are discussed.

Aged↗
PubMed1991

Understanding the uptake of cervical cancer screening: the contribution of the health belief model.

The health belief model, explaining health and illness behaviour, is 25 years old. Criticisms of the model have included its abstract nature and its emphasis on the rationality of patients' behaviour. Its lack of predictive power means it provides a useful framework rather than a true model. The health belief model is used here to review the literature that has advanced our understanding of the factors affecting uptake of cervical screening. The influence of age and social class on perceptions of vulnerability, and the costs and benefits of screening are highlighted. The body of work reviewed has helped expose inherent limitations of screening programmes. The main obstacles to the success of cervical screening are organizational, for example, the inaccuracy of address registers. Numerous ways of encouraging uptake are identified. These include appropriately worded invitations and educational material, personalized approaches from members of the primary health care team and flexible surgery hours. The incentives introduced under the 1990 general practitioner contract are likely to help increase uptake.

Age Factors↗
PubMed1990

Late presentation of congenital dislocation of the hip: an audit.

Despite the widespread introduction of neonatal screening programmes, the late presentation of congenital dislocation of the hip remains a considerable problem. Important gaps in our understanding of the natural history of this condition make it difficult to assess the effectiveness of screening. An audit of late presenting cases of congenital dislocation of the hip in south Bedfordshire between 1980 and 1988 suggests that improved liaison between hospital doctors and general practitioners and closer scrutiny as children start walking could make screening more effective.

Age Factors↗
PubMed1989

Ethnic differences in consultation rates in urban general practice.

OBJECTIVE: To determine the patterns of consultations with the general practitioner among different ethnic groups and the outcome of these consultations. DESIGN: Retrospective analysis of data from one urban group general practice collected during 1979-81 as part of a research project in seven practices. SETTING: Group general practice in the London borough of Brent with a list size of 10,877 patients in July 1980. SUBJECTS: Patients registered with the practice during the 23 months to April 1981 who accounted for 67,197 consultations. MAIN OUTCOME MEASURES: Ethnic state, sex and social class distribution, and diagnosis of patients consulting and frequency of consultations analysed as standardised consultation ratios and standardised patient consultation ratios. RESULTS: Compared with other ethnic groups male Asians (that is, including those born in Britain and those originating from the Indian subcontinent and east Africa) had a substantially increased standardised patient consultation ratio. Consultation rates for mental disorders--in particular, anxiety and depression--were reduced in all groups of immigrant descent. West Indians consulted more frequently for hypertension and asthma, and their children less frequently with otitis media. Asians consulted more frequently with upper respiratory tract infections and non-specific symptoms. Native British patients were more likely to leave the surgery with a follow up appointment, prescription, or certificate. CONCLUSION: Notwithstanding the limitations of this study, ethnic differences in consultation rates were apparent. These differences require further investigation if the needs of minority ethnic groups are not to be overlooked.

Asia↗
PubMed1989

Mortality risk factors in acute protein-energy malnutrition.

The records of 45 children admitted to the Save The Children Fund (UK) Clinic, Dhankuta, East Nepal for nutritional rehabilitation, and who subsequently died, were compared with those of 200 survivors admitted during the same period. Children who died were more likely to have attended the clinic previously (P less than 0.02), and tended to be younger and lighter than controls. A poor outcome was associated with oedema (P less than 0.02), hepatomegaly (P less than 0.01), suspected tuberculosis (P less than 0.001) and various socioeconomic factors: children who died came from larger families, 'single parent' families (P less than 0.01), and were more likely to have lost a sibling (P less than 0.01). The irrigated landholdings of dying children's families were on average approximately half the size of those of survivors' families. These socioeconomic factors were associated with more severe malnutrition at presentation. The identification of factors associated with a poor prognosis can help to focus admission criteria and to monitor especially high-risk children where services for the acutely malnourished are limited.

Body Weight↗
PubMed1987

Sociocultural differences in patients' expectations at consultations for upper respiratory tract infection.

Among 214 patients consulting their general practitioner with upper respiratory tract infection, differences in expectation were apparent between Whites, Afro-Caribbeans and Asians. Significantly more Asians (84%) wanted prescriptions for antibiotics and/or other medication than did Afro-Caribbeans (72%) or Whites (47%) (P<O.001). There were no significant differences in terms of what was received but Asians tended to be dissatisfied with the outcome of the consultation. Self-medication before consultation was attempted by 82% of patients; 48% took two or more preparations. Afro-Caribbeans had taken significantly more preparations per person than other groups (P<0.05). Sociocultural factors may influence patients' expectations at consultations for upper respiratory tract infection.

Consumer Behavior↗