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Biomedical subjects

A Bowling

Publications and source records attributed to A Bowling.

At least 19 recordsLinked to original sources
PubMed1995

Volunteers or victims: patients' views of randomised cancer clinical trials.

Randomised clinical trials are essential for the objective evaluation of different treatment strategies in cancer. However, in the field of oncology, very few of the eligible patients are entered into trials, and most treatments have only been tested on a small percentage of patients. For doctors, a major deterrent to participating in trials is the lack of resources--particularly time, but often also the local facilities. This report suggests that patients themselves are willing to take part in clinical research, and are attracted by being treated by a doctor with a specialist interest in the disease and encouraged by the possibility that their progress will be monitored closely. With the recent NHS changes, it is timely for the Department of Health and other national health departments to consider carefully what can be done to ensure that no new treatments are adopted without effective evaluation. This will require departments of health to identify and implement ways to facilitate accrual of appropriate numbers of patients onto research protocols (whether non-randomised phase I or phase II studies or large, multicentre phase III trials) over short time periods.

Adolescent↗
PubMed1992

Jewish people and ageing: their emotional well-being, physical health status and use of services.

Little is known about what has been termed cultural gerontology, or the experience of ageing among members of particular ethnic minority groups. One of the greatest gaps in current knowledge relates to the subjective health status and use of health services among elderly people in ethnic minorities, particularly those who are Jewish. The research results reported here are from a survey of elderly people in City and Hackney, London. They show that Jewish respondents were more likely than other elderly people to report problems with emotional well-being, mental and physical health problems and problems with functional ability (tasks of daily living). Jewish respondents were also more likely to use services, particularly health services, than other respondents. The associations with service use generally held when controlling for health status.

Age Factors↗
PubMed1991

General practitioners' views on quality specifications for "outpatient referrals and care contracts".

OBJECTIVE: To ascertain general practitioners' views about which quality specifications should be included in contracts for hospital care. DESIGN: In depth interview study and postal survey. SETTING: General practitioners in City and Hackney Health District. SUBJECTS: Fourteen doctors were interviewed in depth; 77 of 131 doctors (59%) returned postal questionnaires. MAIN OUTCOME MEASURE: Rating of listed quality specifications. RESULTS: The most popular items which doctors thought should be included in contracts by April 1991 related to the availability of patients' notes in outpatient clinics, respect shown to general practitioners in telephone communications with hospital doctors, supply of medicines after discharge, patient management plans for general practitioners, the earlier arrival of discharge slips, the type of hospital doctor to see new outpatients, and the unnecessary duplication of investigations. CONCLUSIONS: A high premium was attached by general practitioners to effective organisation, effective communication between primary and secondary sources of care, and effective communication with patients.

Attitude of Health Personnel↗
PubMed1991

Associations with social networks, social support, health status and psychiatric morbidity in three samples of elderly people.

The effects of social network structure, support and physical health status on psychiatric morbidity were investigated among 1415 people over retirement age who took part in three independent but comparable surveys in London (urban area) and Essex (semi rural area). Multivariate analysis showed that the model explained between 14.3% and 28.6% of the variation in psychiatric morbidity in the three samples. Poor health status was a more powerful predictor of psychiatric morbidity than the social network variables. Age and sex contributed little to the model. The model was strongest among the two samples of Hackney respondents.

Activities of Daily Living↗
PubMed1991

Use of services in old age: data from three surveys of elderly people.

It has been suggested that home sharers, particularly spouses, act as substitutes for formal health and social care provision. This hypothesis was investigated in relation to three independent samples of elderly people, using comparable methodology in London (urban area) and Essex (semi-rural area). The uniqueness of the study lies in the ability to make comparisons between younger and older elderly people, in particular with those aged 85 and over. Utilisation of health and social services was found to be higher in the urban area, and it increased with age. Marital status was not associated with service use nor with contact with general practitioners in any age group or area. The social network variables analysed had little or no predictive ability in relation to recency of contact with general practitioners (GPs). Household size was associated with total use of health and social services, and social services in particular. The multivariate analysis confirmed that household size was a strong predictor of use of home help and meals on wheels services; functional status was the best predictor of use of district nursing services.

Activities of Daily Living↗
PubMed1991

A randomized controlled trial of nursing home and long-stay geriatric ward care for elderly people.

This paper reports outcome data on mental and physical ability levels, mortality and accident rates, from a randomized controlled trial evaluating health authority funded nursing home and long-stay geriatric ward care in one inner London health district. There were no differences between settings in mortality rates, although respondents randomized to the nursing homes deteriorated more rapidly in overall, mental and functional ability levels. Previous analyses reported that they also experienced a higher accident rate than respondents in the wards. However, observational data from the evaluation clearly indicated that quality of life in the homes was superior to that in the wards. We conclude that the more rapid physical decline and greater risk of accident in the nursing homes have to be balanced against an inferior quality of life in the hospital, and that a judgement is not easy to make on behalf of other people.

Accidents↗
PubMed1991

Social support and social networks: their relationship to the successful and unsuccessful survival of elderly people in the community. An analysis of concepts and a review of the evidence.

Many studies suggest that there is a relationship between social support and physical and psychological health status, risk of institutionalization and mortality of the elderly. Although longitudinal analyses confirm these suggestions, all studies experience problems with network methodology, and none use comparable operational or working definitions. It is known that there is an effect between these variables, but the nature of the relationship is still unknown. This paper reviews existing research on social networks, social support and associations with health status, mortality and risk of institutionalization.

Aged↗
PubMed1991

Social networks, health, and emotional well-being among the oldest old in London.

A survey of the health and social circumstances of 662 people aged 85 and over, living at home in inner London, was conducted in 1987. A primary aim was to analyze the structure of social support networks of the sample in relation to respondents' emotional well-being and met and unmet needs for practical help. The conceptual and methodological framework that was applied to the study was derived from the theory of social networks. In confirmation of the common assumption that people aged 85+ are different from younger elderly people, as they are the "survivors," high levels of social support and informal help were given to most respondents. Although associations were found between social network variables and the provision of informal help, multifactorial analysis showed that health status explained more of the variation in emotional well-being.

Activities of Daily Living↗
PubMed1991

Nurses' attitudes to elderly people: a survey of nursing homes and elderly care wards in an inner-London health district.

This paper is based on a survey of 104 nurses of varying grades and experience working with elderly people in nursing homes and hospitals in an inner-London health district. The aim was to establish the veracity of a hypothesis which stated that nursing home staff would express greater job satisfaction and perceive their environments more positively than hospital staff. Most nurses in all settings were satisfied with their work, although less than one-third reported their reason for applying for their current post as a preference for working with elderly people. The authors conclude that, although favourable views were recorded, the negativity and dissatisfaction expressed by the nurses is evidence of the low status and appeal of the specialty.

Aged↗
PubMed1990

Locomotor disability in very elderly people: value of a programme for screening and provision of aids for daily living.

OBJECTIVE: To assess the prevalence of potentially reversible locomotor disabilities in elderly subjects and the cost effectiveness of providing aids for daily living. DESIGN: Population based randomised controlled trial of subjects aged greater than or equal to 85 living independently in an inner London borough. SETTING: 21 Electoral wards of the London Borough of Hackney. SUBJECTS: 1255 Subjects aged greater than or equal to 85 living in their own home whose names were obtained from general practitioner lists and cross checked against the electoral register, 511 of whom were subsequently found to be ineligible. Of the 744 remaining, those with disability on screening were randomised and allocated to an intervention group (36) or a control group (43), in which intervention was postponed until four weeks, after the follow up assessment. Subjects with aids supplied previously were excluded from the intervention phase. INTERVENTIONS: Provision of raised toilet seat, teapot tipper, tap turner, shoe horn and elastic laces, and double handled saucepan. MAIN OUTCOME MEASURES: Degree of difficulty (grades 1-4) with specific tasks (getting on and off a toilet, pouring from a teapot into a cup, turning taps on and off, carrying a saucepan of standard weight, and putting on shoes) and time taken to perform them. RESULTS: 545 (73%) Of the 744 eligible subjects assessed; 428 had no disability and 118 had difficulty with at least one task. Some had had their disability recognised before the study and already had aids, representing half of those with difficulty getting on and off the toilet but 24% for putting on shoes and 13% for pouring from a teapot and turning on a tap. The mean number of difficulties was similar between the groups (intervention group 1.7, control group 1.6). Time taken to complete the tasks corresponded with the observed grade of difficulty. All aids were associated with reduced difficulty according to observer assessment (% improvement intervention group v control group: raised toilet seat, 71 v 13 teapot tipper 100 v 33; tap turner 100 v 0; saucepan 88 v 0; shoe horn 50 v 13) and time taken to complete the tasks. A cost benefit analysis of this screening-intervention programme suggested a total cost of 32 pounds per individual benefit. CONCLUSIONS: Appreciable degrees of unrecognised locomotor disability are detected on screening of very elderly people living independently. Providing aids offers a feasible and cost effective means of improving function in such people.

Activities of Daily Living↗
PubMed1990

The prevalence of psychiatric morbidity among people aged 85 and over living at home. Associations with reported somatic symptoms and with consulting behaviour.

A survey of all people aged 85 years and over, living in an inner London borough, was carried out. In 1987, 662 people who lived at home were traced from family practitioner committee records and interviewed. The General Health Questionnaire was administered to measure psychiatric morbidity (after excluding people with evidence of disorientation or confusional states). 27% of respondents were rated as having probable psychiatric morbidity (cases). These cases were more likely to report somatic health problems, particularly those associated with stress. There was no relationship with psychiatric morbidity and age, sex, social network type, or feelings of loneliness. However, fewer of those rated as cases, and who also independently reported problems with nerves, stress or depression, said they had reported these feelings to their general practitioners. Multiple regression analysis showed no significant relationship with General Health Questionnaire score and recency of contact with general practitioners.

Aged↗
PubMed1990

Associations with life satisfaction among very elderly people living in a deprived part of inner London.

In the present study 662 people, aged 85 and over, living at home in a socially deprived part of the east end of London were interviewed in order to ascertain their life circumstances, emotional well-being, mental and physical health status. The aim of the analyses presented here was to determine the impact of social networks and support, functional status and reported morbidity on life satisfaction. Multiple regression analysis showed that physical health status was a stronger predictor of emotional well-being in relation to life satisfaction than social network characteristics. The uniqueness of the study lies in its concentration on a very elderly age group, predominantly in the lower socio-economic classes.

Activities of Daily Living↗
PubMed1990

Quality of everyday life in long stay institutions for the elderly. An observational study of long stay hospital and nursing home care.

The observational study reported here was part of a wider evaluation of long stay care for elderly people. The observational study showed that it was essential not to rely on interview material alone. Qualitative techniques provided insights into behaviours, moods and interactions which would have been difficult to measure using traditional survey techniques. The data collected was analysed in relation to the theory of the total institution and disengagement theory. Although the survey data presented evidence of block treatment of individuals in both long stay hospital wards and smaller nursing homes for the elderly, the observational study showed that only the ward setting conformed closely to Goffman's concept of the total institution. In addition, the study indicated that involvement in activities and interaction with others promotes positive feelings among elderly people, and questions the validity of disengagement theory.

Affect↗
PubMed1990

Injuries to dancers. Prevalence, treatment and prevention.

Studies from the USA and UK indicate that the back, neck and shoulder and the lower limb (particularly the hip, knee, ankle and foot) are the most frequent sites of injury among dancers. Most injuries are soft tissue injuries. Most dancers experience injuries at some time and about half have chronic injuries. Shoulder injuries appear to be caused by frequent or unaccustomed lifting, and are treated by rest and oral anti-inflammatory medication. Back injuries include sprains, prolapsed or herniated intervertebral discs, and spondylolytic stress fractures. Several risk factors, especially training error, have been identified for overuse injuries. Hip injuries include degenerative changes and osteoarthritis, stress fractures, bursitis and damage to the sciatic nerve. The most common foot injury is an anterior lateral ligament sprain, which may lead to permanent instability in the ankle. More soundly based research into the prevalence, diagnosis and treatment of injuries is needed.

Dancing↗
PubMed1989

The White Paper and the elderly.

If government proposals for primary care are fully implemented, there will be a conflict between the requirement to seek out illness in elderly patients and the ability to deliver treatment. Budget holding practices may have particular problems and the government's intention that patients should have greater choice may be jeopardised.

Aged↗
PubMed1989

Injuries to dancers: prevalence, treatment, and perceptions of causes.

A survey of injuries to dancers was commissioned by the National Organisation of Dance and Mime. Questionnaires asking about chronic and recent injuries were sent to 188 dancers and completed by 141 dancers from seven professional ballet and modern dance companies in the United Kingdom (75% response rate). It was found that of the 141 dancers, 67 (47%) had experienced a chronic injury and 59 (42%) an injury in the previous six months that had affected their dancing. A high proportion of injuries to the soft tissues had not responded to treatment. With correct treatment such injuries should usually heal completely. Dancers are aware of the high rate of injuries and also of procedures that might help to prevent injury--for example, dancing on floors that are sprung and in warmer studios; teachers' and choreographers' awareness of a dancer's limitations and the need for rest and adequate treatment when an injury occurs.

Adolescent↗