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S Michie

Publications and source records attributed to S Michie.

50 records · Page 3Linked to original sources
PubMed1992

The psychological effects of false-positive results in prenatal screening for fetal abnormality: a prospective study.

The purpose of the study was to describe the impact of false-positive results from initial maternal serum alpha-fetoprotein (MS-AFP) screening. The analyses compared two groups of women, those receiving a negative result (n = 346) and those receiving an initial positive result (n = 26), over four time points--prior to testing, immediately after testing, later in pregnancy, and in the post-partum period. Receiving an abnormal result was associated with high levels of anxiety which were reflected in increased worry about the baby's health and a more negative attitude towards the pregnancy and the baby. Women who had an initial abnormal result were offered a variety of further tests. Those women who went on to have amniocentesis were less worried about their baby's health in the third trimester and also less anxious post-partum than those who did not have amniocentesis. In view of the increasing number of screening tests available, it is necessary to establish whether and how these levels of distress can best be reduced.

Adult↗
PubMed1992

Psychological effects of having amniocentesis: are these due to the procedure, the risk or the behaviour?

The purpose of the study was to examine the impact of amniocentesis on women at risk for having a baby with Down's syndrome because of raised maternal age. Fifty-four of the study participants had amniocentesis and nine did not. At the time of the procedure, those having amniocentesis were significantly more anxious, less certain about the baby's health, and held more negative attitudes towards the baby than women who did not undergo amniocentesis. For women undergoing amniocentesis there was a positive association between perceived risk of having an abnormal baby and anxiety. After the baby's birth, women who had undergone amniocentesis held less positive attitudes to the baby and were significantly more worried about the baby's health. These results suggest that the anxiety surrounding amniocentesis is related both to the procedure and to the perceived likelihood of an abnormal result. The differences between the groups after the birth seem more likely to reflect pre-existing attitudinal differences between the two groups, than the effects of amniocentesis.

Adaptation, Psychological↗
PubMed1991

Perceived risk not actual risk predicts uptake of amniocentesis.

A consecutive cohort of 71 women eligible for amniocentesis because they were over 38 years of age completed questionnaires during the first trimester of pregnancy. Sixty-one women underwent amniocentesis, an uptake rate of 86%. Uptake was associated with a less negative attitude towards termination of an affected baby and a higher perceived risk of the fetus being abnormal. It was not associated with actual age-related risks. There was no significant relation between actual risk and perceived risk. The results of this study suggests that it is important for doctors to understand the basis of women's decisions to have amniocentesis, and the difference between actual and perceived risk if they are to communicate effectively with women about the test and their options.

Abortion, Therapeutic↗
PubMed1990

Cognitive predictors of attendance at antenatal classes.

This study investigates what factors discriminate between women attending and those not attending antenatal classes in a sample of 94 primigravidous women. The 20 per cent of the sample who did not attend were less positive about the classes, more likely to evaluate the costs of attending as outweighing the benefits and more likely to think that avoiding them may help them cope. The best predictor of antenatal class attendance was women's intention at 28 weeks of pregnancy. The inclusion of demographic and attitude variables did not improve the accuracy of prediction. The most variable predicting intention was women's 'cost/benefit' judgement.

Adaptation, Psychological↗
PubMed1989

The impact of prenatal screening and diagnostic testing upon the cognitions, emotions and behaviour of pregnant women.

The purpose of most screening and diagnostic tests is to initiate treatment when a problem is found and, otherwise, to allay anxiety. The extent to which the second of these objectives is met was studied in a prospective study of 179 pregnant women. Women who had amniocentesis to detect Down's Syndrome or were screened for a fetal neural tube defect had significantly lower anxiety levels in the third trimester of pregnancy than women who did not undergo these tests. Undergoing screening for a neural tube defect was also associated with a more positive attitude towards the pregnancy in the second trimester. These results suggest that the previously reported raised levels of anxiety in women undergoing such tests do not necessarily remain high for the duration of the pregnancy and, indeed, undergoing testing may serve to protect women against high levels of anxiety in the third trimester of pregnancy.

Adult↗
PubMed1988

Expression of T cell receptor delta chains in benign and malignant T lineage lymphoproliferations.

Recent studies in both human and murine systems have demonstrated the existence of a second CD3-associated T cell receptor (the gamma delta-TCR) distinct from the alpha beta heterodimer associated with antigen recognition by classical T cells. Using a monoclonal antibody specific for the delta component of the human gamma delta-TCR, the expression of this antigen in both benign, reactive lymphoid tissues and T lineage lymphomas was studied with immunohistologic techniques. In the normal thymus, TCR-delta+ cells constituted less than 5% of the CD3+ thymocytes and were located primarily in the medulla or juxtamedullary cortex. Within the T zones of 16 histologically varied reactive peripheral lymphoid tissues, including four patients with marked predominantly paracortical hyperplasia, the authors identified from less than 1% to a maximum of 5% TCR-delta+ cells. While these results are consistent with the hypothesis that TCR-gamma delta+ cells comprise a small distinct subpopulation of peripheral T cells in humans, selective localization or recruitment of these cells could not be demonstrated in any of a number of tissues or reactive situations. Among 62 T lineage lymphomas, including 14 CD3+/TCR-beta- cases, only two TCR-delta+ neoplasms were identified, both lymphoblastic lymphomas displaying the CD3+/CD4-/CD8- phenotype known to be associated with normal TCR-gamma delta+ T cells. Because the majority of CD3+/TCR-beta- lymphomas did not display TCR-delta, these results argue against the hypothesis that the high incidence of CD3/TCR-beta discordance noted in T lineage lymphomas represents preferential transformation of the TCR-delta-expressing subset.

Humans↗
PubMed1985

In vivo prevention of thyroid and pancreatic autoimmunity in the BB rat by antibody to class II major histocompatibility complex gene products.

Evidence is accumulating that the development of insulin-dependent diabetes mellitus involves autoimmune phenomena, both in the human and in the BB rat model. A strong association is observed in both cases with alleles of the class II major histocompatibility complex (MHC). Results of the present study show that autoimmune phenomena, as assessed by the presence of clinical diabetes or histological thyroiditis, are prevented by the injection of monoclonal antibodies to class II gene products in the BB rat. Immunosuppression was specifically obtained with a monoclonal antibody to the murine I-E equivalent, as opposed to the murine I-A equivalent, of the rat major histocompatibility complex. This represents indirect evidence for I-E subregion control of immune responses to islet cell and thyroid antigens in the BB rat model. The frequent occurrence of anaphylactic type deaths in young (1 month old) animals receiving more than six weekly injections of partially purified homologous (rat) monoclonal antibodies to rat class II gene products underscores the potential risks of this type of immunotherapy. The presumed immunologic mechanism (IgE antibody) and its specificity (anti-allotype, anti-idiotype, or anti-impurity) must be clarified to assess the risks and feasibility of this type of therapy.

Anaphylaxis↗
PubMedDate not supplied

The psychological consequences of offering mutation searching in the family for those at risk of hereditary breast and ovarian cancer--a pilot study.

AIM: To describe the short and longer-term psychological consequences of waiting for the results of mutation searching (MS) amongst those at risk of hereditary breast and ovarian cancer (HBOC). DESIGN: A prospective study, with measures before the offer of a mutation search, and 1 week, 6 months and 12 months afterwards. SAMPLE: 21 unaffected women at risk of HBOC offered MS in an affected relative at one of two UK regional genetics centres. OUTCOME MEASURES: Standardized questionnaire measures of general anxiety, general distress, distress about cancer in the family and cancer-specific worries. RESULTS: Mutation searches were initiated in 15 of 21 families; two received results within 12 months. For the 13 still waiting for results, levels of anxiety and distress were within normal ranges at all time-points. They reported reduced worries about cancer 6 and 12 months post-search offer compared with earlier assessments, but experienced an increase in general anxiety 12 months since the search offer. These changes over time were not found in those not waiting for the results of a mutation search. CONCLUSION: The majority of women were without a result 12 months after being offered MS. Whilst these women were less worried about cancer in the 6 months after initiating the testing process, their anxiety levels increased 12 months since the offer of a mutation search. Seeing a specialist seems to reduce cancer worries. There may, however, be long-term psychological costs of offering tests that are unlikely to give results in a foreseeable future.

Adult↗
PubMedDate not supplied

Genetic counselling: information given, recall and satisfaction.

The aims of this study are to categorise the key points given in genetic counselling, assess the amount and type of information recalled, and examine the relationships between counsellees' knowledge, satisfaction with information received, the meeting of expectations, concern and anxiety. Because of the variety of consultations, a knowledge questionnaire of the key points was constructed for each individual counsellee, with acceptable inter-rater reliability. The information items judged to be the key points in the consultations were assigned to 13 different content categories. Thirty-two counsellees were sent a questionnaire assessing knowledge and other outcomes two to four weeks after attending a genetic counselling consultation. The mean percentage of key points recalled correctly was 76% (s.d. 17%) with 100% recall for family issues and 68-78% recall for genetic or medical information. Knowledge was not associated with satisfaction with information received nor with level of concern or anxiety following genetic counselling. These results suggest the importance of assessing multiple outcomes of genetic counselling.

Adult↗
PubMedDate not supplied

Information recall in genetic counselling: a pilot study of its assessment.

One of the main aims of genetic counselling is to provide information to patients that they can understand and recall. Measuring information recall is problematic and most studies do not make the comparison between recalled information and the information that is given in consultations. The aim of this study was to determine the validity of using genetic counsellors' reports of information given in genetic consultations as the basis for a measure of patient recall. Counsellors in 35 routine genetic counselling consultations were asked to indicate important information given during consultations by highlighting items in their summary letters sent to patients. This was checked by a researcher against tape-recordings of the consultations. One month later, patients were telephoned by the researcher and asked to recall as much information as they could from the consultation and to rate its importance. Over 95% of the information that counsellors identified as important had been given during the consultation. Patients rated this information as important. Although there was an association between the overall number of items that counsellors and patients judged to be important, patients more frequently judged information about family implications to be important than did counsellors. On the other hand, counsellors more frequently judged information about test, diagnosis and prognosis to be important than did patients. These results suggest that counsellors' summary letters are a valid baseline against which to measure patient recall. This measure will not, however, capture all the information that patients consider important.

Adolescent↗
PubMedDate not supplied

Stress in nursing and patients' satisfaction with health care.

The aim of this study was to investigate the factors that contribute to the stress reported by nurses and patients. Thirty-four nurses in a London teaching hospital completed the nurse stress index and the Spielberger state trait anxiety inventory, and attitudes towards the ward and nursing care were measured in 52 patients. Nurses in the sample reported significantly greater problems than the norm in dealing with stress (as measured by the nurse stress index). In particular, they expressed difficulty in dealing with patients and their relatives, with conflict between home and work, and with and pressure resulting from problems concerning confidence and competence in the role. Patients were generally satisfied with the health care they received. There was a positive relationship between the time that patients spent talking to nurses and the degree to which nurses were perceived as helpful. Results are discussed in terms of possibilities for further research and implications for the design of future intervention programmes aimed at reducing job-related stress in hospitals.

Adult↗