Biomedical subjects
Publications and source records attributed to W M Simpson.
This study provides the first baseline estimate of the impact of indoor IFA infestations in all 46 counties of our state. Clinicians need to be alert to the threat of unprovoked stings and possible anaphylaxis among disabled or confined patients in a variety of indoor settings.
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Before any new antenatal screening test is introduced, the opinions of pregnant women should be considered. This is particularly relevant with HIV testing. This qualitative study reports the views of 29 women attending an antenatal clinic in a large maternity hospital in Scotland where a trial of different ways of offering HIV testing on a universal, voluntary basis occurred. Women were in favour of a test offer, although they did not necessarily wish to accept testing for themselves. Generally they were more worried about having an unhealthy baby. There was a commonly held view that routine testing would cause less anxiety because it would eliminate the stigma of saying yes to testing. A move towards the HIV test being recommended to pregnant women as opposed to merely offered is likely to be acceptable, would probably increase uptake rates and should therefore be assessed.
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Imported fire ants are now firmly established in all 46 counties of South Carolina. In 1998 there were an estimated 660,000 cases in the state of which approximately 33,000 sought medical treatment at an estimated cost of 2.4 million dollars. Residents and visitors are at risk for IFA attacks that may occur indoors as well as outdoors. While IFA sting victims in endemic areas of the state may be less likely to seek medical treatment, patients in recently infested areas seem to be more likely to seek treatment since they are relatively unfamiliar with the multiple, painful IFA stings and pustules. Citizens need to control IFA infestations around and within their homes according to guidelines recommended by the Clemson University Cooperative Extension Service. Regional IFA control programs were discontinued in the past because of costs and environmental chemical concerns. Obviously, we need to support ongoing research aimed at developing improved and safe strategies for the local and regional control of IFA.
OBJECTIVE: To determine the uptake and acceptability of different methods of a universal offer of voluntary HIV testing to pregnant women. DESIGN: Randomised controlled trial involving four combinations of written and verbal communication, followed by the direct offer of a test. The control group received no information and no direct offer of a test, although testing was available on request. SETTING: Hospital antenatal clinic covering most of the population of the city of Edinburgh. SUBJECTS: 3024 pregnant women booking at the clinic over a 10 month period. MAIN OUTCOME MEASURES: Uptake of HIV testing and women's knowledge, satisfaction, and anxiety. RESULTS: Uptake rates were 6% for those in the control group and 35% for those directly offered the test. Neither the style of leaflet nor the length of discussion had an effect on uptake. Significant independent predictors of uptake were a direct test offer; the midwife seen; and being unmarried, previously tested, and younger age. Knowledge of the specific benefits of testing increased with the amount of information given, but neither satisfaction nor anxiety was affected by the type of offer. CONCLUSIONS: The universal offer of HIV testing is not intrusive and is acceptable to pregnant women. A policy of offering the HIV test to all women resulted in higher uptake and did not increase anxiety or dissatisfaction. Uptake depends more on the midwife than the method of offering the test. Low uptake rates and inadequate detection of HIV infection point to the need to assess a more routine approach to testing.
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The occupational and environmental medicine (OEM) gap in US medical education is widely recognized. In 1992, a federal initiative stimulated a primary care approach to improve residency training in South Carolina. This three-part report documents progress in designing and implementing an OEM curriculum, which is family medicine-centered. Each of the state's residency training programs participate in an ongoing Environmental Medicine Curriculum Committee effort. Part 1, discusses the needs assessment; Part 2, the five key elements of curriculum; and Part 3 details a clinical guide to the OEM patient.
Part II of our three-part report examines five of the key elements for occupational and environmental medicine (OEM) training in family medicine residency. These were introduced by the Environmental Medicine Curriculum Committee (EMCC) faculty in South Carolina under a Department of Energy (DOE) grant to the Environmental Hazards Assessment Program (EHAP) of the Medical University of South Carolina, 1992-1997. Each element is being designed, tested, and updated by clinicians in the residency network. A pilot study of 100 third-year medical students conducted in 1996 suggests the difficulty in implementing OEM skills in current family medicine training.
A four-prototype approach to the occupational and environmental medicine (OEM) patient in a busy primary care setting is described. A 2 x 2 table illustrates the two diagnostic, interrelated tasks during the outpatient, non-urgent visit: (a) sick? yes/no, and (b) exposed? yes/no. One may have the basic skills for task (a) but feel insecure for task (b). With OEM experience, creative use of resources (databases and consultants), and patient cooperation, a better balance between task (a) and task (b) can be achieved. The Environmental Medicine Curriculum Committee (EMCC) initiative described in Part I and Part II of this study has developed this patient-centered model to help the resident in training cope as he or she tries to deal with emerging patient concerns from the workplace and beyond. In November 1996, an expert panel of consultants representing OEM, public health, and family medicine endorsed the prototype OEM patient model for further development.
The success of cardiovascular disease (CVD) risk factor screening programmes depends heavily on good uptake rates and the extent of risk factors modification following screening. It is thus important to try to understand what affects people's decision to attend a screening appointment and their motivation to change their lifestyle, if necessary, following screening. This paper summarises three studies undertaken to describe uptake of screening and risk factor modification and to identify the psychological factors involved. The studies took place in two settings: a worksite mobile screening service and a city health centre screening programme. The results identified a number of sociodemographic, personal and organizational factors involved in screening behaviour which offer suggestions for effective planning of screening programmes.
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It is common for patients seen by primary care physicians to be taking both nonsteroidal anti-inflammatory drugs (NSAIDs) and antihypertensive agents. If blood pressure control diminishes in these patients, the physician must evaluate the potential interaction between the two classes of medication. Although the increase in blood pressure secondary to NSAID use may be only 5 to 10 mm Hg, this increase may be enough to justify a change in medication. For this reason, it is important to evaluate the interaction between the two types of drugs and determine its clinical significance in specific patients.
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Depression, grief, and dementia are conditions frequently encountered among the community-living elderly. This review offers a primary care perspective of the distinguishing features for each and discusses the special issues of managing the elderly. Major depression in the elderly usually responds to antidepressant medication, whether the depression occurs alone (endogenous) or as a response to another condition (reactive).
It has been said that those who cannot find time for exercise will most certainly find time for illness. This is especially true for the elderly. Physicians need to provide encouragement and instruction to help the older patient to begin and to continue an exercise program that is designed to avoid injury.