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Abstract
To investigate whether tonsillar size was related to human morphology, age or duration of disease, 100 consecutive patients undergoing tonsillectomy for recurrent tonsillitis were investigated. The lengths, widths and volumes of each resected tonsil were measured and compared with patient characteristics ascertained on the day before surgery. The volume of tonsillar tissue was directly related to height (ρ=0.46, P<0.001) and weight (ρ=0.45, P<0.001) and age, but at any age (or body size) there was a wide range of tonsil size. A weak inverse relationship was found with the duration of recurrent tonsillitis. Tonsil size is of no relevance in the assessment of recurrent tonsillitis or adenoid hypertrophy.
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Affiliation(s)
- I K Crombie
- Department of Community Medicine, Ninewells Hospital & Medical School, Dundee
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Crombie IK. Book Review: Clinical Effectiveness Made Easy. Scott Med J 2016. [DOI: 10.1177/003693300104600620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Perera SM, Vadiveloo T, Donnan PT, Sniehotta FF, Crombie IK, Feng Z, McMurdo MET, Witham MD. 43 * THE RELATIONSHIP BETWEEN SUBJECTIVE AND OBJECTIVE MEASUREMENTS OF PHYSICAL ACTIVITY IN COMMUNITY DWELLING OLDER PEOPLE. Age Ageing 2015. [DOI: 10.1093/ageing/afv031.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Crombie IK, Falconer DW, Irvine L, Williams B, Ricketts IW, Humphris G, Norrie J, Rice P, Slane PW. Reducing alcohol-related harm in disadvantaged men: development and feasibility assessment of a brief intervention delivered by mobile telephone. Public Health Research 2013. [DOI: 10.3310/phr01030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
AbstractBackgroundSocially disadvantaged men suffer substantial harm from heavy drinking. Brief alcohol interventions are effective in reducing consumption when delivered via health care. There is a need for tailored brief interventions for disadvantaged men who seldom attend health care.Objectives(1) To investigate the best ways to recruit and retain disadvantaged men in a study aimed at reducing the frequency of heavy drinking. (2) To identify the type of content and timing of the delivery that is most likely to engage disadvantaged young to middle-aged men in an intervention delivered by text messages. (3) To determine whether or not the intervention is likely to be an acceptable way to influence the frequency of heavy drinking.DesignA three-phase study involving the development of the recruitment strategy and the intervention, an assessment of the feasibility of a randomised controlled trial, and a post-study evaluation.SettingCommunity-based study, conducted in Dundee, UK.ParticipantsDisadvantaged men aged 25–44 years who had two or more episodes of heavy drinking (≥ 8 units in a single session) in the preceding month. Two recruitment strategies were employed: recruitment through general practice (GP) registers and recruitment through a community outreach strategy.InterventionsFocus groups explored drinking motives and behaviours of the target group. The intervention also drew on reviews of the literature on: alcohol brief interventions, text message studies, communication theory and behaviour change theories and techniques. The intervention group received 36 text messages with images sent over a 28-day period.Main outcome measuresThe outcome measures evaluated the likely success of a full trial: recruitment of the participants; construction and delivery of a theoretically and empirically based intervention that successfully engages disadvantaged men; potential for the intervention to influence binge drinking.ResultsThe focus group analyses identified that personal experience and knowledge of the harmful effects of alcohol was widespread. Furthermore, there was a discrepancy between frequent binge drinking and perceived social expectations and duties. This could usefully be targeted in the intervention. Theoretically and empirically based behaviour change strategies were successfully rendered in attractive, colourful, brief text messages. Both recruitment strategies (GP registers and community outreach) proved successful and a total of 67 men were recruited, exceeding the target of 60. The participants were at high risk of harm because of frequent episodes of heavy binge drinking. Baseline interviews established that those recruited through community outreach drank substantially more and had more frequent binge drinking sessions than those recruited through GP registers. Retention at follow-up was 96%. Extensive process evaluation was conducted. The evaluation showed that 95% of text messages were successfully delivered to participants' telephones. Furthermore, there was a high level of engagement with text messages which sought responses. Most men replied to these texts, often giving carefully structured personal responses. Analyses of the responses indicated a high level of engagement with key components of the behaviour change strategy. Post-trial evaluation showed high levels of satisfaction with the intervention.ConclusionsThis study has shown that disadvantaged men can be recruited and retained in an alcohol intervention trial. A theoretically and empirically based intervention was successfully delivered by text message. Furthermore, the messages were well received and elicited the types of response intended. A full trial of the intervention, incorporating a cost-effectiveness study, should be carried out.Study registrationThis study is registered as ISRCTN10515845.FundingThe National Institute for Health Research Public Health Research programme.
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Affiliation(s)
- IK Crombie
- School of Medicine, University of Dundee, Dundee, UK
| | - DW Falconer
- School of Medicine, University of Dundee, Dundee, UK
| | - L Irvine
- School of Medicine, University of Dundee, Dundee, UK
| | - B Williams
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, University of Stirling, Stirling, UK
| | - IW Ricketts
- School of Computing, University of Dundee, Dundee, UK
| | - G Humphris
- School of Medicine, University of St Andrews, St Andrews, UK
| | - J Norrie
- Centre for Health Care Randomised Trials, University of Aberdeen, Aberdeen, UK
| | - P Rice
- NHS Substance Abuse Services, Stracathro Hospital, Brechin, UK
| | - PW Slane
- The Erskine Practice, Arthurstone Medical Centre, Dundee, UK
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Denison HJ, Syddall HE, Martin HJ, Finucane FM, Griffin SJ, Wareham NJ, Cooper C, Sayer AA, Ramsay I, Fantin F, Zamboni M, Wright J, Morrison C, Bulpitt C, Rajkumar C, Wilkinson AH, Burton LA, Jones AL, Moni JJ, Witham MD, Bhangu J, Woods C, Robinson D, Shea DO, O'Connell J, Kennedy C, Romero-Ortuno R, O'Shea D, Robinson D, O'Shea D, Kenny RA, O'Connell J, Roche J, Argo I, Crombie IK, Feng Z, Sniehotta FF, Vadiveloo T, Witham MD, Donnan PT, McMurdo MET, Barrett MP, Sinha A, Wilson I, Chan S, Webb PJ. Other medical conditions. Age Ageing 2013. [DOI: 10.1093/ageing/aft023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Crombie IK, Precious E. Changes in the Social Class Gradient of Cirrhosis Mortality in England and Wales across the 20th Century. Alcohol Alcohol 2010; 46:80-2. [DOI: 10.1093/alcalc/agq074] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
This systematic review assesses weight loss interventions in young adults (18-25 years), who are vulnerable to weight gain. This age group experience critical life course points (leaving home for higher studies or job, pregnancy, cohabitation) and develop/establish lifestyle and behavioural patterns making this an opportune intervention period. Medline, Embase, Cinahl, PsychINFO and Cochrane Library were searched (1980 to March 2008). All trials and cohort studies with control groups that assessed weight loss interventions in this specific age group were included finally identifying 14 studies. Before and after comparison of behavioural/motivational interventions (-2.40 kg; 95% CI -5.4 to 0.6) and combination interventions (-2.96; 95% CI -4.4 to -1.5) consistently showed weight loss. Behavioural/motivational interventions increased self-efficacy, the desire to control weight, boosted self-esteem, and increased satisfaction with body areas and appearance. Interventions also showed improvements in HDL cholesterol, insulin, glucose and maximum oxygen uptake. However, recruitment to participation in interventions was a barrier for this age group with small sample sizes and short-term interventions. There may be gender differences in preference to participation in certain type of interventions. Further research to understand attitudes towards healthy lifestyle and preferences of interventions is needed to develop suitable interventions for this vulnerable age group.
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Affiliation(s)
- A S Poobalan
- Section of Population Health, University of Aberdeen, Aberdeen, UK.
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Evans JMM, Shelia CM, Kirk A, Crombie IK. Tracking of physical activity behaviours during childhood, adolescence and young adulthood: a systematic review. J Epidemiol Community Health 2009. [DOI: 10.1136/jech.2009.096701i] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Smith WC, Crombie IK, Tunstall-Pedoe HD, Tavendale R, Riemersma RA. Cardiovascular risk factor profile and mortality in two Scottish cities. Acta Med Scand Suppl 2009; 728:113-8. [PMID: 3202020 DOI: 10.1111/j.0954-6820.1988.tb05562.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Edinburgh and Glasgow are the two largest cities in Scotland, which has one of the highest coronary heart disease mortality rates in the world. Within Scotland, there is a geographical variation in these rates and Glasgow has a higher mortality rate than Edinburgh. However, the cities also differ socially and economically. Population surveys have been conducted in centres in both Edinburgh and North Glasgow using the MONICA project methods. These surveys were performed simultaneously in 1986 in men and women aged 25-64 years. Preliminary analysis shows that the differences in cigarette smoking, blood pressure and body mass index in men and women between the two centres are consistent with the difference in cardiovascular mortality. However there is no difference between the centres in reported exercise levels, and the difference in mean serum total cholesterol between the centres is in the opposite direction to that expected. Possible explanations of these differences are discussed.
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Affiliation(s)
- W C Smith
- Scottish MONICA Project, Ninewells Hospital & Medical School, Dundee, UK
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10
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Abstract
BACKGROUND Limited information is available on the carcinogenic risk associated with narrowband TL-01 UVB phototherapy in humans. OBJECTIVES To determine the skin cancer incidence in a population treated with TL-01 phototherapy. PATIENTS AND METHODS All TL-01-treated patients were identified from the departmental computerized database. Patients with malignant melanoma (MM), squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) were identified by record linkage with the Scottish Cancer Registry. The incidence of each was compared with the normal Scottish population matched for age and sex. RESULTS Data were obtained from 1908 patients. The median follow-up duration was 4 years (range 0.04-13). The median cumulative number of TL-01 treatments and dose were 23 (1-199) and 13 337 (30-284 415) mJ cm(-2), respectively. No increased incidence of SCC or MM was observed. Ten patients developed BCC compared with an expected 4.7 in the Scottish population [standardized rate ratio 213 (95% confidence interval 102-391); P < 0.05]. CONCLUSIONS A small but significant increase of BCC was detected in the TL-01 group. This could be explained by a number of factors, including ascertainment bias. To determine the true carcinogenic risk of TL-01 phototherapy, longer follow-up is essential.
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Affiliation(s)
- I Man
- Photobiology Unit, Department of Dermatology and Department of Public Health and Epidemiology, University of Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK.
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Abstract
BACKGROUND The number of voluntary organizations active in health care is considerable. There have been recent calls for a new closer working relationship between voluntary bodies and the National Health Service. The relationship between the two healthcare sectors needs to be efficient and harmonious in the interests of patient care; however, little is known about the nature and problems in the current relationship. The present study was undertaken to examine aspects of this relationship from the point of view of health board personnel. OBJECTIVE To identify the practices and views of Scottish health board staff concerning the funding, role and responsibility of voluntary organizations in the health sector. METHODS A qualitative study based on in-depth interviews with health board officials in all 15 Scottish health boards. RESULTS Policies for financial and other relationships with the voluntary sector were often not explicit. The levels and method of funding voluntary health organizations varied across boards, as did the tenure of awards (from 1 to 3 years). Demand for funding far exceeded monies available. Some health boards ensured accountability through audited accounts, annual reports and site visits; however, others thought this inappropriate for small organizations. Health boards recognized the problems of the precariousness of funding and the administrative burden of the monitoring process and the ritual of applying for funding. CONCLUSION The uncertainties of long-term funding may impede the contribution of voluntary organizations. There is a tension between the requirements of clinical governance and the ability of small voluntary organizations to provide the necessary documentation. One proposed solution, to reduce the number of organizations, might not appeal to the voluntary sector. Future initiatives could address the problem of tailoring funding and accounting to the resources of voluntary organizations.
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Affiliation(s)
- D R Coid
- Director of Medical Services, Armadale Health Service, PO Box 460, Armadale 6992, Western Australia.
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12
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Abstract
Compliance with asthma medication is recognised to be a problem. Acquisition of medication is the first step towards compliance. Factors predicting poor collection of prophylactic medication were investigated. A case/control study was conducted. Cases were children who had had at least two consultations for poorly controlled asthma in 1 yr and collected prescriptions of prophylactic medication irregularly. Controls were children whose prescriptions were collected as instructed. Levels of knowledge about asthma and asthma medication were high in both groups. Parents of cases were more likely to perceive their child's asthma to be moderate or severe and more likely to report that their child's asthma was not well controlled. They reported more night-time symptoms, exercise symptoms and school absence. Parents of cases were less likely to report that administering inhalers was part of the evening routine. They were less likely to perceive their child's prophylactic medication to be very effective and more reluctant to administer prophylactic medication. Some parents may decide to undertreat their children, although lack of organised routine may contribute to poor compliance. Parents need guidance on interpreting symptoms and support in establishing routines for the administration of medication.
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Affiliation(s)
- L Irvine
- Dept of Epidemiology & Public Health, University of Dundee, Ninewells Hospital & Medical School, Dundee, UK.
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Hutcheon SD, Gillespie ND, Crombie IK, Struthers AD, McMurdo MET. Perindopril improves six minute walking distance in older patients with left ventricular systolic dysfunction: a randomised double blind placebo controlled trial. Heart 2002; 88:373-7. [PMID: 12231595 PMCID: PMC1767356 DOI: 10.1136/heart.88.4.373] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To evaluate the effects of the angiotensin converting enzyme inhibitor perindopril on six minute walking distance and quality of life in very old patients with left ventricular systolic dysfunction. DESIGN Prospective, double blind placebo controlled trial. SETTING Medicine for the elderly day hospital. PATIENTS 66 patients (average age 81) with left ventricular systolic dysfunction identified by echocardiography. INTERVENTIONS 10 weeks of treatment with titrated doses of perindopril or placebo. MAIN OUTCOME MEASURES Six minute walking distance 10 weeks following treatment, quality of life measurements including the Minnesota living with heart failure questionnaire and the 36 item short form health survey. RESULTS In patients with left ventricular systolic dysfunction, six minute walking distance was significantly increased in the treatment group (37.1 m) compared with the placebo group (-0.3 m, p < 0.001). The medication was well tolerated and there were no significant adverse events. CONCLUSIONS Six minute walking distance is improved considerably by treatment with perindopril in older patients with heart failure caused by left ventricular systolic dysfunction.
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Affiliation(s)
- S D Hutcheon
- Section of Ageing & Health, Department of Medicine, University of Dundee, Ninewells Hospital, Dundee, UK
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14
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James PB, Crombie IK. Epidemiology and profit for pharmaceutical companies. Lancet 2002; 359:1621. [PMID: 12048000 DOI: 10.1016/s0140-6736(02)08501-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Coid DR, Crombie IK. What do we know about the voluntary healthcare sector in Scotland? Health Bull (Edinb) 2001; 59:224-7. [PMID: 12664730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
OBJECTIVE To document sources of information available to the National Health Service in Scotland (NHSiS) which relate to the health voluntary sector. DESIGN Interrogation of the databases of the Charities Register in Scotland (CRIS) and Health Education Board for Scotland (HEBS) for information on health voluntary organisations and a retrospective review of information held on health voluntary organisations recently funded by health boards. SETTING National Health Service in Scotland and the Scottish Council for Voluntary Organisations RESULTS Nine hundred and fifty six health voluntary organisations in Scotland were registered with the CRIS database. Five hundred and forty five (57%) of these had annual incomes of less than 100,000 Pounds and two thirds of them (630) operated at a local level. Information on 3,106 health and support organisations was present on the HEBS database. In 1997-98 Scottish Health Boards grant funded 278 voluntary organisations. Eighty seven (31%) of these had information held on the CRIS database and another 87 (31%) with the HEBS database. Funding was much more likely to be given to organisations dealing with adult physical health and alcohol problems. Organisations dealing with specific diseases were less likely to be funded. Of the 87 funded organisations registered with CRIS, health boards typically contributed less than 10% of annual funding. CONCLUSIONS Health planning decisions are made difficult by a deficiency of useful information on the existence, activities and financial positions of voluntary organisations. Construction of accurate and comprehensive national databases to inform these decisions would be expensive. However, the development of appropriate local databases by health boards and the voluntary sector would facilitate the development of a constructive partnership.
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Affiliation(s)
- D R Coid
- Department of Epidemiology and Public Health, Ninewells Hospital and Medical School, Dundee
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Abstract
Sampling, or selecting a group of people to represent a whole population, lies at the heart of almost all research designs. There are many ways of going about this, each of which presents its own problems. The trick is to obtain a good-sized sample that is truly representative of the population as a whole.
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Affiliation(s)
- J P Davis
- Department of Epidemiology and Public Health, University of Dundee, Ninewells Hospital and Medical School, Dundee
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Crombie IK. Book Review: Statistics with Confidence (Second Edition). Scott Med J 2001. [DOI: 10.1177/003693300104600220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
Screening has generally been successful in identifying those at risk from disease. This success has led to the belief that screening in the general population is always a good thing. However, there are pitfalls which must be avoided if screening programmes are to achieve what is intended for them.
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Affiliation(s)
- J P Davis
- Department of Epidemiology and Public Health, University of Dundee, Ninewells Hospital and Medical School, Dundee
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Abstract
BACKGROUND Passive smoking is a major cause of respiratory morbidity in children. However, few studies give accurate estimates of the health effects of passive smoking in children with asthma using an objective measure of exposure. The effects of passive smoking using salivary cotinine levels to measure exposure were investigated. METHODS A sample of 438 children aged 2-12 years with asthma who had a parent who smoked were recruited in Tayside and Fife, Scotland. Health service contacts for asthma, assessed from GP case records, were used as a proxy for morbidity. RESULTS A weak U-shaped relationship was found between the salivary cotinine level and health service contacts for asthma: compared with low cotinine levels those with moderate cotinine levels had a reduced contact rate (relative rate (RR) = 0.91, 95% confidence interval (CI) 0.80 to 1.05), whereas high cotinine levels were associated with an increased rate of contact (RR = 1.19, 95% CI 1.05 to 1.37). In contrast, a strong association was seen with the amount the parent reported smoking in front of the child: the higher the level the fewer visits were made for asthma (RR for everyday exposure = 0.66, 95% CI 0.56 to 0.77). This effect was not seen for non-respiratory visits. Demographic factors, age of child, and number of children in the family all had a powerful effect on the number of visits for asthma. The parents' perception of asthma severity was associated with visit frequency independent of actual severity (derived from drug treatment). CONCLUSION High levels of parental smoking in the home are associated with a reduction in health care contacts for asthma. This could be due to a lack of awareness of asthma symptoms among heavy smokers or a reluctance to visit the GP. Children with asthma who have parents who smoke heavily may not be receiving adequate management.
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Affiliation(s)
- I K Crombie
- Department of Epidemiology and Public Health, University of Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK.
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Abstract
OBJECTIVE To determine the prognosis for resolution of abnormal cutaneous photosensitivity in patients with chronic actinic dermatitis (also known as the photosensitivity dermatitis and actinic reticuloid syndrome). DESIGN Historical cohort study involving follow-up of patients for up to 24 years from diagnosis. SETTING A Scottish tertiary referral center for investigation of photodermatosis. PATIENTS One hundred seventy-eight patients with chronic actinic dermatitis, 62% of a cohort of 285 living patients identified in the Photobiology Unit database. INTERVENTIONS Recall for repeated clinical assessment and monochromator phototesting. All patients underwent patch testing when initially assessed; this was repeated at follow-up in a subgroup of patients. MAIN OUTCOME MEASURES Resolution of abnormal photosensitivity, defined as clinical resolution and return of phototest responses to within normal population limits. In addition, possible prognostic factors for resolution of photosensitivity were examined. RESULTS The probability of abnormal photosensitivity resolving by 10 years from diagnosis is 1 in 5. Particularly severe abnormal UV-B photosensitivity (minimal erythema dose at 305+/-5 nm half-maximum bandwidth, < or =5.6 mJ x cm(-2)) and the identification of separate contact allergens in 2 or more patch test batteries are predictors of a poorer prognosis for resolution. Loss of contact allergies was not associated with a different prognosis for photosensitivity resolution. Our findings probably underestimate the probability of resolution, as those referred to a tertiary referral center and willing to attend for follow-up may include a disproportionate number of severely affected patients. CONCLUSIONS Newly diagnosed patients can be told that most of them will improve with appropriate UV/visible light and allergen avoidance and that there is hope that their photosensitivity will completely resolve.
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Affiliation(s)
- R S Dawe
- Photobiology Unit, Department of Dermatology, Ninewells Hospital and Medical School, Dundee, DD1 9SY, Scotland.
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Coid DR, Crombie IK, Murray MD. Grant funding of health voluntary organizations by Scottish health boards. Public Health 2000; 114:320-3. [PMID: 11035448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
The objective of this study was to identify grant funding of voluntary organizations by Scottish health boards in the financial year 1997-1998. Scottish health board financial commitments to voluntary organizations were surveyed. Fifteen health board Directors of Finance participated in the study. The outcome measures were relative and absolute commitments of grant expenditure to the voluntary sector by health boards in Scotland. Total expenditure of Scotland's 15 health boards ranged from zero to 764,910 pounds sterling. One health board did not support any voluntary organizations while the greatest number supported by an individual health board was 43. Of health boards that made grants to voluntary bodies the range of expenditure per head of resident population was 0.09 pounds sterling-3.00p pounds sterling. The average grant expenditure to voluntary organizations ranged from 1,839 pounds sterling to 30,308 pounds sterling. The most substantial funding fell to voluntary bodies within the fields of mental health, alcohol and community elderly care. However, there was substantial variation between health boards in whether these bodies were funded, and to what extent funding was given. In conclusions, health boards have conflicting practices in funding voluntary organizations. Although there may be some variation in the needs of voluntary bodies across health boards, this is unlikely to explain the scale of the variation. Further work is required to explain this phenomenon and to propose policies for the support of the voluntary sector by the National Health Service that are acceptable to both funders and providers of services.
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Affiliation(s)
- D R Coid
- Department of Epidemiology and Public Health, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK.
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Johnston G, Davies HT, Crombie IK. Improving care or professional advantage? What makes clinicians do audit and how well do they fare? Health Bull (Edinb) 2000; 58:276-85. [PMID: 12813807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
OBJECTIVE To find out why clinicians undertake audit, the extent to which they complete the process of audit and their perception of the benefits of taking part. DESIGN Semi-structured interviews. SETTING Twelve trusts in three Scottish Health Boards. SUBJECTS One hundred and forty five respondents of different status from a wide range of clinical specialities. RESULTS Sixty six per cent of respondents defined clinical audit as a means of making changes with a view to improving care, but 62% reported the purpose of audit as the examination of the usefulness of treatment or the observation of practice. Personal reasons for taking part included justifying practice (32%) and as a means of professional development (15%). Twenty one percent held formal minuted meetings, the majority were informal. Sixty six percent of clinicians completed a project plan but pilot studies (49%) and re-audits (26%) were less common. Twenty four percent changed practice as a result of the audit. The extent to which the audit process had been completed predicted clinicians' ability to make changes. CONCLUSION Clinicians' understanding of the concept of audit was not translated into practical projects. The main reasons for this are the organisational difficulties clinicians are faced with when carrying out audit and a lack of attention to all parts of the audit process. Despite this failure to achieve change, many clinicians felt they had benefited from their experience of audit. Management should appeal to these motivations of employees and provide a culture which enforces their importance over and above changing practice.
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Affiliation(s)
- G Johnston
- Department of General Practice, Queen's University of Belfast, Dunluce Health Centre, 1 Dunluce Avenue, Belfast
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Abstract
Case-control studies are largely used to explore differences between groups of individuals. They can identify potential risk factors associated with disease, or they can investigate patient behaviour, such as why some people do not attend for services. As such, case-control studies are often used to generate or test hypotheses about causal factors. Nonetheless, bias is always a danger in case-control studies, arising especially from the way in which study samples are selected or from the collection of retrospective data. Confounding also remains a problem. This short paper explores ways in which such flaws can be uncovered in published studies.
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Affiliation(s)
- H T Davies
- Department of Management, University of St Andrews, Fife
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Abstract
OBJECTIVE To review the literature on the benefits and disadvantages of clinical and medical audit, and to assess the main facilitators and barriers to conducting the audit process. DESIGN A comprehensive literature review was undertaken through a thorough review of Medline and CINAHL databases using the keywords of "audit", "audit of audits", and "evaluation of audits" and a handsearch of the indexes of relevant journals for key papers. RESULTS Findings from 93 publications were reviewed. These ranged from single case studies of individual audit projects through retrospective reviews of departmental audit programmes to studies of interface projects between primary and secondary care. The studies reviewed incorporated the experiences of a wide variety of clinicians, from medical consultants to professionals allied to medicine and from those involved in unidisciplinary and multidisciplinary ventures. Perceived benefits of audit included improved communication among colleagues and other professional groups, improved patient care, increased professional satisfaction, and better administration. Some disadvantages of audit were perceived as diminished clinical ownership, fear of litigation, hierarchical and territorial suspicions, and professional isolation. The main barriers to clinical audit can be classified under five main headings. These are lack of resources, lack of expertise or advice in project design and analysis, problems between groups and group members, lack of an overall plan for audit, and organisational impediments. Key facilitating factors to audit were also identified: they included modern medical records systems, effective training, dedicated staff, protected time, structured programmes, and a shared dialogue between purchasers and providers. CONCLUSIONS Clinical audit can be a valuable assistance to any programme which aims to improve the quality of health care and its delivery. Yet without a coherent strategy aimed at nurturing effective audits, valuable opportunities will be lost. Paying careful attention to the professional attitudes highlighted in this review may help audit to deliver on some of its promise.
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Affiliation(s)
- G Johnston
- Department of General Practice, Queen's University of Belfast, Dunluce Health Centre, UK
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26
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Abstract
Semi-structured interview were conducted with 145 clinicians from a variety of clinical backgrounds in twelve Trusts across three Scottish health boards. Questions examined barriers to the audit process and obstacles that impeded the implementation of changes in response to the audit findings as well as the need for resources to facilitate the audit activity. The most difficult part of the audit process was reported as data collection (32%) but almost half of respondents would have changed the way the audit was done with hindsight. The biggest barrier to doing the audit was perceived as lack of time (33%). Colleagues' attitudes posed the biggest obstacles to making changes as a result of the audit (26%). Few perceived the need for more resources but preferred focused and proactive support from managers and audit support staff. Trusts need to work harder at creating cultures where clinical audit is supported and actively encouraged.
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Affiliation(s)
- G N Johnston
- Department of General Practice, Queen's University of Belfast.
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27
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Abstract
Cohort studies allow an exploration of patient change over time. They can provide information on the incidence of disease, prognosis (including patient satisfaction) and likely health-care resource use. Nonetheless, bias can be present in cohort studies in the way patients are selected and followed-up, the way measures are taken, or the way data are analysed. This short paper explores ways in which such flaws can be uncovered in published studies, so that their findings can be interpreted appropriately.
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Affiliation(s)
- H T Davies
- Department of Management, University of St Andrews, Fife
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Affiliation(s)
- D R Coid
- Department of Epidemiology and Public Health, Dundee University Medical School, Ninewells Hospital
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Irvine L, Crombie IK, Clark RA, Slane PW, Feyerabend C, Goodman KE, Cater JI. Advising parents of asthmatic children on passive smoking: randomised controlled trial. BMJ 1999; 318:1456-9. [PMID: 10346773 PMCID: PMC27890 DOI: 10.1136/bmj.318.7196.1456] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate whether parents of asthmatic children would stop smoking or alter their smoking habits to protect their children from environmental tobacco smoke. DESIGN Randomised controlled trial. SETTING Tayside and Fife, Scotland. PARTICIPANTS 501 families with an asthmatic child aged 2-12 years living with a parent who smoked. INTERVENTION Parents were told about the impact of passive smoking on asthma and were advised to stop smoking or change their smoking habits to protect their child's health. MAIN OUTCOME MEASURES Salivary cotinine concentrations in children, and changes in reported smoking habits of the parents 1 year after the intervention. RESULTS At the second visit, about 1 year after the baseline visit, a small decrease in salivary cotinine concentrations was found in both groups of children: the mean decrease in the intervention group (0.70 ng/ml) was slightly smaller than that of the control group (0.88 ng/ml), but the net difference of 0.19 ng/ml had a wide 95% confidence interval (-0.86 to 0.48). Overall, 98% of parents in both groups still smoked at follow up. However, there was a non-significant tendency for parents in the intervention group to report smoking more at follow up and to having a reduced desire to stop smoking. CONCLUSIONS A brief intervention to advise parents of asthmatic children about the risks from passive smoking was ineffective in reducing their children's exposure to environmental tobacco smoke. The intervention may have made some parents less inclined to stop smoking. If a clinician believes that a child's health is being affected by parental smoking, the parent's smoking needs to be addressed as a separate issue from the child's health.
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Affiliation(s)
- L Irvine
- Department of Child Health, Ninewells Hospital and Medical School, Dundee DD1 9SY.
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30
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Crombie IK. Book Review: Our NHS — A Celebration of 50 Years. Scott Med J 1999. [DOI: 10.1177/003693309904400215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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31
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Davies HT, Crombie IK. Getting to grips with systematic reviews and meta-analyses. Hosp Med 1998; 59:955-8. [PMID: 10696361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Systematic reviews and meta-analyses now form a major source of evidence on clinical effectiveness. Despite the relative recency of this approach to synthesizing research findings, a reasonable consensus has emerged as to the desirable methodological characteristics of this secondary research. Understanding these basic tenets enables readers to take a balanced view of published review findings.
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Affiliation(s)
- H T Davies
- Department of Management, University of St Andrews, Fife
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32
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Crombie IK, McLoone P. Does the availability of prescribed drugs affect rates of self poisoning? Br J Gen Pract 1998; 48:1505-6. [PMID: 10024711 PMCID: PMC1313200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
The trends in self-poisoning rates and in rates of prescribing of the major drug groups were compared. Over the period 1981-91, barbiturate prescribing and self poisoning both fell by 80%; for antidepressants, prescribing increased by over 40% and self poisoning by 30%; for antipsychotics, both rose by 30%; for benzodiazepines, poisoning fell by 30% and prescribing by 20%. Even for analgesic drugs, which are also available over the counter, there was a correspondence between changes in self poisoning and prescribing. The availability of prescribed drugs is directly related to their use for self poisoning. Restricting the availability of these drugs is a possible preventative strategy, although further research on this is needed.
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Affiliation(s)
- I K Crombie
- Department of Epidemiology and Public Health, Ninewells Hospital and Medical School, Dundee
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33
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Abstract
Alcohol abuse is strongly associated with suicide. Alcoholics are at a high risk of suicide, and studies of case series of suicide show that alcoholics account for between 20% and 40% of all suicides. What is less clear is the role of alcohol in the events leading up to the suicide. This study reviews the characteristics of individuals who consumed alcohol prior to suicide. All cases of suicide assessed by the Department of Forensic Medicine, Dundee University between 1988 and 1995 were reviewed. Data were obtained on blood-alcohol levels of 349 cases, together with the method and circumstances of the suicide, demographic variables and reports of past psychiatric history. Forty-five per cent of suicide cases had consumed alcohol and 19% were drunk (BAC > 150 mg/dl) at the time of the suicide. Consumption of alcohol was not associated with a particular method of suicide, nor with social factors such as employment status, marital status or social class. However, alcohol use was more common among those with no previous psychiatric history. This study confirms that alcohol consumption is a common precursor to suicide. It suggests that alcohol may play a more important role in the events leading to suicide amongst individuals with no previous psychiatric history.
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Affiliation(s)
- I K Crombie
- Department of Epidemiology and Public Health, Dundee University, Dundee, UK
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34
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Crombie IK, McQuay HJ. The systematic review: a good guide rather than a guarantee. Pain 1998; 76:1-2. [PMID: 9696452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Crombie IK, Davies HT, Macrae WA. Cut and thrust: antecedent surgery and trauma among patients attending a chronic pain clinic. Pain 1998; 76:167-71. [PMID: 9696470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Surgery and trauma are recognised as important causes of chronic pain, although their overall contribution has not been systematically studied. This paper reports on the contribution of surgery and trauma to chronic pain among 5130 patients attending 10 outpatient clinics located throughout North Britain. Surgery contributed to pain in 22.5% of patients, and was particularly associated with the development of pain in the abdomen and with anal, perineal and genital pain. Trauma was a cause of pain in 18.7% of patients, and was most common in pain in the upper limb, the spine and the lower limb. Patients with chronic pain associated with trauma are on average younger than those with chronic post-surgical pain. Further, and unusually for pain conditions, the trauma patients show an excess of males over females. These findings indicate that it can be unhelpful for pain classification systems to combine surgery and trauma in a single category. The results also point to areas for potentially fruitful research into the aetiology of chronic pain. In particular, studies are needed to identify the operative procedures associated with the development of pain so that preventive measures can be implemented.
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Affiliation(s)
- I K Crombie
- Department of Epidemiology and Public Health, University of Dundee Ninewells Hospital and Medical School, UK
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36
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Affiliation(s)
- H T Davies
- Department of Management, University of St Andrews
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37
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McCowan C, Neville RG, Thomas GE, Crombie IK, Clark RA, Ricketts IW, Cairns AY, Warner FC, Greene SA, White E. Effect of asthma and its treatment on growth: four year follow up of cohort of children from general practices in Tayside, Scotland. BMJ 1998; 316:668-72. [PMID: 9522793 PMCID: PMC28474 DOI: 10.1136/bmj.316.7132.668] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To investigate whether asthma or its treatment impairs children's growth, after allowing for socioeconomic group. DESIGN 4 year follow up of a cohort of children aged 1-15. SETTING 12 general practices in the Tayside region of Scotland. SUBJECTS 3347 children with asthma or features suggestive of asthma registered with the general practices. MAIN OUTCOME MEASURES Height and weight standard deviation scores. RESULTS Children who lived in areas of social deprivation (assessed by postcode) had lower height and weight than their contemporaries (mean standard deviation score -0.26 (SD 1.02) and -0.18 (1.15) respectively, P < 0.001 for both). Children who were receiving > or = 400 micrograms daily of inhaled steroids and who were attending both hospital and general practice for asthma care had lower height and weight than average, independent of the effect of deprivation (mean standard deviation score -0.62 (1.01), P = 0.002, for height and -0.58 (0.94), P = 0.005, for weight). Children receiving high doses of inhaled corticosteroids also showed lower growth rates (mean change in standard deviation score -0.19 (0.51), P = 0.003). However, no other children with asthma showed growth impairment. CONCLUSION Most children with asthma were of normal height and weight and had normal growth rates. However, children receiving high doses of inhaled steroids and requiring both general practice and hospital services had a significant reduction in their stature. This effect was independent from but smaller than the effect of socioeconomic group on stature.
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Affiliation(s)
- C McCowan
- Tayside Centre for General Practice, University of Dundee
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38
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Abstract
The use of process measures in the assessment of the quality of care has been neglected of late. The outcomes movement has gathered momentum and process measurement appears to have been left trailing in the wake. Yet process measures can be sensitive indicators of the quality of care and have many advantages over outcomes. They are readily measured and can easily be interpreted; comparisons are not essential (as they are with outcomes monitoring) but even if used they are little bothered by the case-mix arguments which bedevil outcomes assessment. Further, the direct measurement of process can directly indicate deficiencies of care which need to be remedied. Finally, there are some aspects of care which are only amenable to study using measures of process. These benefits come at a price: first there must be good evidence that links the processes of care to desirable outcomes. This paper explores the advantages of measuring processes of care in quality assessment and advocates a balanced approach to the process vs. outcome debate.
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Affiliation(s)
- I K Crombie
- Department of Epidemiology & Public Health, University of Dundee, Ninewells Hospital & Medical School, UK
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39
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Crombie IK. Over half of proposed indicators for hospitals' performance relate to surgery. BMJ 1998; 316:70. [PMID: 9451283 PMCID: PMC2665337 DOI: 10.1136/bmj.316.7124.70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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40
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41
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Abstract
BACKGROUND Children with parents who smoke are often exposed to high levels of environmental tobacco smoke, and children with asthma are particularly susceptible to the detrimental effects of passive smoking. Data were collected from parents who smoke and from their asthmatic children. The families are currently taking part in a randomised controlled trial to test an intervention designed to reduce passive smoking in children with asthma. This paper reports on the baseline data. Questionnaire data and cotinine levels were compared in an attempt to assess exposure and to identify factors which influence exposure of the children. The aim of the study was to identify the scope for a reduction in passive smoking by these children. METHODS A sample of 501 families with an asthmatic child aged 2-12 years was obtained. Factors influencing passive smoking were assessed by interviewing parents. Cotinine levels were measured from saliva samples using gas liquid chromatography with nitrogen phosphorous detection. RESULTS Cotinine levels in children were strongly associated with the age of the child, the number of parents who smoked, contact with other smokers, the frequency of smoking in the same room as the child, and crowding within the home. Parental cotinine levels, the amount smoked in the home, and whether the home had a garden also exerted an independent effect on cotinine levels in the children. CONCLUSIONS Many children are exposed to high levels of environmental tobacco smoke and their cotinine levels are heavily dependent upon proximity to the parent who smokes. Parents who smoke have a unique opportunity to benefit their child's health by modifying their smoking habits within the home.
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Affiliation(s)
- L Irvine
- Department of Child Health, Ninewells Hospital, Dundee, UK
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42
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Abstract
Interest in outcomes is universal. To patients, good outcomes represent their highest hopes for therapy; to health care professionals, good outcomes are the desired end-point of a complex web of care. More recently, politicians and health care managers too have shifted their emphasis away from health service activity and towards what is termed 'health gain'. The rise of the outcomes movement appears irresistible. However, the difficulties in interpreting outcomes data will not go away. Outcomes measured using routine data are subject to numerous biases and many practical difficulties. Despite recent statistical, methodological and technological advances, comparisons of outcomes at best provide us with weak evidence of either the effectiveness or the quality of health care. And sometimes they may frankly mislead. The apparent intuitiveness of outcomes monitoring has broad public appeal. But enthusiasm for outcomes needs to be tempered with a clear understanding of their limitations.
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Affiliation(s)
- H T Davies
- Department of Management, University of St Andrews, UK
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43
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Davies HT, Crombie IK, Brown JH, Martin C. Diminishing returns or appropriate treatment strategy?--an analysis of short-term outcomes after pain clinic treatment. Pain 1997; 70:203-8. [PMID: 9150294 DOI: 10.1016/s0304-3959(96)03320-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
In the United Kingdom patients with chronic pain are frequently managed in anaesthetist-led outpatient pain clinics. In many of these clinics the emphasis is on medical therapies (analgesics and psychotropic drugs, TENS, acupuncture and nerve blocks) with patients trying a series of different therapies until relief is achieved or further attempts at physical treatments are discontinued. The sequential trial of different treatment modalities presents clinicians with a problem. Patients who receive little benefit from (say) the first three treatments tried might be expected to be less likely to gain benefit from the next treatment modality. The presence or absence of such 'diminishing returns' from treatment will influence when therapeutic efforts based on the medical model of pain should be abandoned. This study examined basic outcome data on 1912 patients seen in a single Scottish pain clinic between 1987 and 1994. The data were analysed to assess whether the success of treatment modalities depended on whether they were used as a first-choice treatment or were given after previous therapeutic attempts had failed. Diminution in success rates was generally not large although this varied between therapies. No fall-off in success rates was seen for antidepressants, acupuncture or sympathetic nerve blocks. However, the other nerve blocks all showed falling success rates when they were used as fourth- or fifth-line treatments. That little diminution of success rates was seen warrants further investigation. Pain clinics need good information on the success or otherwise of late treatment so that they can devise rational pain management strategies covering multiple therapies and appropriate criteria for ending medical interventions. These findings suggest that allowing patients access to multiple pain therapies may well be an appropriate management strategy.
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Affiliation(s)
- H T Davies
- Department of Management, University of St Andrews, St Katharine's West, The Scores, Scotland, UK.
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McCowan C, Neville RG, Crombie IK, Clark RA, Warner FC. The facilitator effect: results from a four-year follow-up of children with asthma. Br J Gen Pract 1997; 47:156-60. [PMID: 9167319 PMCID: PMC1312922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND A long-term evaluation of the process and outcomes of primary and secondary care is required to establish whether audit facilitators can improve the care of childhood asthma. AIM To examine the long-term effect of an intervention by an audit facilitator on the management of children with asthma, and to investigate the implications for health service costs. METHOD A 4-year follow up was conducted of an intervention and control group totalling 2557 children aged 1-15 years from 12 general practices in the Tayside region. Primary care consultations, prescriptions, hospital contacts and health service costs 1 year before and 3 years after a facilitator visited practices were recorded. The facilitator encouraged the diagnosis and treatment of childhood asthma in the intervention group. RESULTS Favourable changes in consultation patterns, prescriptions and reduced hospital admissions seen during the intervention year did not persist in subsequent years. Two and three years after the facilitator visit the process and outcome of care was similar in both groups. The reduction in health service costs seen in the intervention group was equivalent to the cost of employing a facilitator. CONCLUSION The effect of a facilitator lasts only for the period of intervention. Enthusiasts will say that improving patient care without increasing health service costs justifies the widespread deployment of facilitators. Others more interested in long-term outcomes may disagree.
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Affiliation(s)
- C McCowan
- Tayside Centre for General Practice, University of Dundee
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45
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Abstract
This project aimed to investigate the height and weight of children with asthma in the community. The Tayside Childhood Asthma Project examined medical records of 3143 children drawn from 12 general practices, for details of asthma morbidity and management. Concurrently, but independent from it, the Tayside Growth Study measured heights and weights of children aged 3-5, 5, 7, 9, 11 and 14 years. This paper reports on a cross-sectional analysis of 699 children who were known to be receiving some form of asthma medication during the school years 1990-91 and 1991-92 when a growth measurement was recorded. A standard deviation score (SDS) was calculated from height measurements for this cohort of children and from weight and body mass index (BMI = weight/height2) measurements for 559 of these children. The mean and standard deviation of these SDS values were calculated, and the distribution of the scores plotted. The results showed no difference in height, weight or BMI between the general population and the cohort receiving asthma medication. However, further analysis showed the distribution of height for children with severe asthma receiving high doses of inhaled corticosteroids (mean -0.38, SD 0.95) was significantly different from the general population (mean 0, SD 1). This group of children appeared to be shorter, by as much as 2 cm on average for a 5-year-old boy. In general, children receiving treatment for asthma within the community have a similar distribution of height and weight to normal children. Children receiving high-dose inhaled corticosteroids are shorter than their contemporaries, and deserve long-term follow-up.
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Affiliation(s)
- R G Neville
- Asthma & Growth in Tayside Children, Tayside Centre for General Practice, Dundee, UK
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46
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Abstract
BACKGROUND Rates of self-poisoning fell during the 1980s, although recent reports suggest this trend may have reversed. METHODS Data on all hospital discharges with a diagnosis of deliberate self-poisoning were obtained from the Information and Statistics Division of the NHS in Scotland. Rates of self-poisoning were investigated by overall trend, and for trends by age and by type of drug. RESULTS Deliberate self-poisoning rates for men and women began increasing in the late 1980s, and did so steadily during the early 1990s. Because the rates are increasing faster in men, the traditional excess of self-poisoning among women is being eroded. For men rates increased in all age groups up to the age of 60, but the greatest rise occurred between ages 15-29. For women the increase was largely restricted to 15-24-year-olds, and rates fell among women over the age of 50. Self-poisoning with paracetamol increased most rapidly; in contrast to aspirin which showed little change. Opiate analgesics, antirheumatics, antidepressants and antipsychotics have also shown some increase in their use in both genders. There has been a substantial fall in the use of benzodiazepines in women, but little change among men. CONCLUSION Rapid increases in self-poisoning particularly among young adults present a serious public health problem. Controlling this epidemic is made difficult because the principal drug involved, paracetamol, is readily available.
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Affiliation(s)
- P McLoone
- Public Health Research Unit, University of Glasgow
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47
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Abstract
This audit study took place in ten outpatient pain clinics and focused on the management of low back pain and nerve-damage pain. The objective was to identify and promote appropriate changes in management. An analysis of the treatment of 1236 patients with low back pain and/or nerve-damage pain highlighted wide variations in practice. Presentation of these data to the clinics was used as a means of promoting change. Data on a further 1791 patients were used to assess the extent of any changes in practice. Prior to the audit feedback, treatments were used often in some clinics, but only rarely in other clinics, for seemingly similar patients. During the feedback sessions three treatments were identified for more frequent use by several of the clinics: antidepressant and anticonvulsant drugs, and transcutaneous electrical nerve stimulation. Many changes in practice occurred after the audit intervention, with large increases in the utilisation of these three treatments. Since there is reasonable evidence to support the use of these treatments for chronic pain this represents an improvement in the process of care. The audit demonstrated that patient management can be improved by a combination of active feedback and discussions based around comparisons between centres.
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Affiliation(s)
- H T Davies
- Department of Epidemiology & Public Health, University of Dundee
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McCowan C, Bryce FP, Neville RG, Crombie IK, Clark RA. School absence--a valid morbidity marker for asthma? Health Bull (Edinb) 1996; 54:307-13. [PMID: 8783484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine how often children with asthma are absent from school compared to the 'average' child and to assess the validity of school absence as a marker of morbidity for asthma. DESIGN Case control study. SETTING Children registered with 12 general practices, attending 98 primary and secondary schools in the Tayside region. SUBJECTS 773 children with asthma or related symptoms and 773 controls from school registers. MAIN OUTCOME MEASURES Episodes of school absence and days absent per term, recorded from school registers. RESULTS Comparing children taking asthma medication against their controls showed a significant difference for both days absent and episodes of absence. This increase in absence was approximately one school day each term. Severity of asthma was not related to increased school absence. Children receiving no asthma medication, but with asthma related symptoms, were absent no more than their age/sex matched controls. Applying a deprivation index to the cases on asthma medication, gave a significant difference in episodes of absence between Primary children classified as highly deprived and other Primary children. CONCLUSION The increase in school absence of around one day per term for children with asthma is less than previously reported and could be caused by clinic attendance rather than ill health due to asthma. Recorded absence varied according to deprivation index but not asthma severity. The use of school absence as a marker of morbidity in childhood asthma needs to be reassessed.
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Affiliation(s)
- C McCowan
- University of Dundee, Tayside Centre for General Practice, Tayside
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49
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Abstract
Using a large data base of respiratory morbidity in children the opportunity arose to explore the link between what was written in general practice case records and the subsequent risk of a child developing an asthma attack or hospital admission due to asthma. Children with five or more consultations in one year for respiratory symptoms had a 33% risk of experiencing an asthma attack or 7.1% risk of admission in the following year. Twenty seven percent of children who received antibiotics for "respiratory infections" subsequently had an asthma attack. The potential exists to review past and present symptoms and thus attempt to predict future morbidity. Childhood asthma is an example where the quality of care offered by general practitioners could be improved if a precise estimate of risk could be used to modify clinical management.
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Affiliation(s)
- R G Neville
- Tayside Centre for General Practice, University of Dundee
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50
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