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Biomedical subjects

Antony Arthur

Publications and source records attributed to Antony Arthur.

11 recordsLinked to original sources
PubMed2006

Evaluating a community-based walking intervention for hypertensive older people in Taiwan: a randomized controlled trial.

OBJECTIVE: To study the effect of a community-based walking intervention on blood pressure among older people. METHOD: The study design was a randomized controlled trial conducted in a rural area of Taiwan between October 2002 and June 2003. A total of 202 participants aged 60 years and over with mild to moderate hypertension was recruited. Participants randomized to the intervention group (n=102) received a six-month community-based walking intervention based on self-efficacy theory. A public health nurse provided both face-to-face and telephone support designed to assist participants to increase their walking. Control group participants (n=100) received usual primary health care. Primary outcome was change in systolic blood pressure and secondary outcomes were exercise self-efficacy, self-reported walking and diastolic blood pressure. RESULTS: At six-month follow-up the mean change in systolic blood pressure was a decrease of 15.4 mmHg and 8.4 mmHg in the intervention and control group, respectively. The difference in mean change between the two groups was -7.0 mmHg (95% CI, -11.5 to -2.5 mmHg, p=0.002). Improvement in exercise self-efficacy scores was greater among intervention group participants (mean difference 1.23, 95% CI, 0.5 to 2.0, p=0.001). Intervention group participants were more likely to report walking more (p<0.0005) but no differences were observed in diastolic blood pressure (p=0.19). CONCLUSIONS: Among hypertensive older people, a six-month community-based walking intervention was effective in increasing their exercise self-efficacy and reducing systolic blood pressure.

Age Factors↗
PubMed2006

Conducting a critical interpretive synthesis of the literature on access to healthcare by vulnerable groups.

BACKGROUND: Conventional systematic review techniques have limitations when the aim of a review is to construct a critical analysis of a complex body of literature. This article offers a reflexive account of an attempt to conduct an interpretive review of the literature on access to healthcare by vulnerable groups in the UK METHODS: This project involved the development and use of the method of Critical Interpretive Synthesis (CIS). This approach is sensitised to the processes of conventional systematic review methodology and draws on recent advances in methods for interpretive synthesis. RESULTS: Many analyses of equity of access have rested on measures of utilisation of health services, but these are problematic both methodologically and conceptually. A more useful means of understanding access is offered by the synthetic construct of candidacy. Candidacy describes how people's eligibility for healthcare is determined between themselves and health services. It is a continually negotiated property of individuals, subject to multiple influences arising both from people and their social contexts and from macro-level influences on allocation of resources and configuration of services. Health services are continually constituting and seeking to define the appropriate objects of medical attention and intervention, while at the same time people are engaged in constituting and defining what they understand to be the appropriate objects of medical attention and intervention. Access represents a dynamic interplay between these simultaneous, iterative and mutually reinforcing processes. By attending to how vulnerabilities arise in relation to candidacy, the phenomenon of access can be better understood, and more appropriate recommendations made for policy, practice and future research. DISCUSSION: By innovating with existing methods for interpretive synthesis, it was possible to produce not only new methods for conducting what we have termed critical interpretive synthesis, but also a new theoretical conceptualisation of access to healthcare. This theoretical account of access is distinct from models already extant in the literature, and is the result of combining diverse constructs and evidence into a coherent whole. Both the method and the model should be evaluated in other contexts.

Health Services Accessibility↗
PubMed2005

The role of sensory and cognitive function in the onset of activity restriction in older people.

BACKGROUND: Extending healthy active life expectancy is a priority if we are to achieve gains in both the quality and quantity of life lived at older ages. We investigated the role of sensory (vision and hearing) and cognitive function on the onset of activity restriction in older people. METHODS: A survey of a total population (N = 1579) of people aged 75 years and older, registered with a large general population in Melton Mowbray, Leicestershire, England, was undertaken in 1988 and linked with subsequent routine health assessments (up to a maximum of five) over 10 years. Activity restriction was defined as having difficulty performing on their own, requiring help or aids or not doing any one of seven Activities of Daily Living (ADLs). The study population comprised the 643 persons who were not restricted at baseline. Cox proportional hazard regression models were fitted to time of onset of activity restriction with those dying before activity restriction was reported being censored at time of death. RESULTS: After adjustment for confounding factors (socio-demographic and psychosocial factors, physical health and physical functional limitations), difficulty with both vision and hearing conferred a doubling of risk of activity restriction (RR = 2.36, 95% CI 1.31 to 4.28). A unit decrease in the Information/Orientation subtest was associated with a 10% increase in risk (RR = 1.10, 95% CI 1.02 to 1.19), even after adjustment for vision and hearing as well as other confounding factors, though baseline Mini-Mental State Examination score was not indicative of increased risk (RR= 1.02, 95% CI 0.98 to 1.06). CONCLUSION: Differentiating whether disability is a result of physical, sensory or cognitive functional limitations, is necessary to identify need and the direction in which efforts should be targeted to improve active life expectancy in older people.

Activities of Daily Living↗
PubMed2005

The challenge of recruiting people with schizophrenia to a health promotion trial.

People with schizophrenia have an increased risk of coronary heart disease. This pilot study tested the feasibility of carrying out a randomised controlled trial to compare coronary heart disease prevention for this population through an enhanced occupational therapy support intervention versus a practice-based intervention. Difficulty in deciding whether to take part meant that 123 visits were made to 25 people with 12 ultimately providing informed consent. Participants' discussion at a subsequent focus group (n = 3) suggested a poor understanding of the study process. Distrust of randomisation suggests that randomised controlled trials may not be the best way to evaluate community-based interventions for people with schizophrenia.

Coronary Disease↗
PubMed2004

Organising services for influenza vaccination for older people.

OBJECTIVES: To follow up a trial of home-administered influenza vaccination of older people to explore reasons for their immunisation behaviour, including their views on the organisation of services. METHODS: Follow-up of original trial using analysis of records of 1865 older people and semi-structured interviews of 25 older people. RESULTS: A once-off home visit does not appear to result in sustained changes in immunisation behaviour. Older people's behaviour appears to be largely explained by their beliefs about immunisation; the organisation of services may exert only small effects. Older people can be characterised as belonging to one of four groups in their orientation towards influenza vaccination: the 'faithful', who are keen to have vaccination; the 'converts', who have been persuaded of the benefits of vaccination and are likely to self-initiate appointments for vaccination; the 'easy-going', who require prompting for vaccination; and the 'sceptics', who perceive influenza vaccination to be ineffective or to be irrelevant for them because of their perceived inherent resistance to influenza. The last group sees vaccination as a form of interference and may be resistant to home visits to administer the vaccine. CONCLUSIONS: Targets for immunising older people require more debate because of the delicate balance between achieving herd immunity and preserving autonomy and choice for older people.

Aged↗
PubMed2003

Are gender differences in the relationship between self-rated health and mortality enduring? Results from three birth cohorts in Melton Mowbray, United Kingdom.

PURPOSE: The purpose of this study was to assess whether there is an enduring gender difference in the ability of self-rated health to predict mortality and investigate whether self-reported physical health problems account for this difference. DESIGN AND METHODS: Cox models for 4-year survival were fitted to data from successive cohorts aged 75-81 years registered with a primary care practice in the U.K. Midlands surveyed in 1981, 1988, and 1993-1995. RESULTS: Self-rated health was consistently a stronger predictor in men (hazard ratio [HR] = 2.7; 95% confidence interval [CI] = 2.1-3.5) than it was in women (HR = 1.9; 95% CI = 1.5-2.4). Women surveyed in 1993-1995 were more likely than men to report problems that were disabling but not life-threatening, whereas men were more likely to report potentially life-threatening problems. However, these differences did not explain the association of self-rated health with mortality. More than half of those who reported a potentially life-threatening problem said that their health was good. IMPLICATIONS: Self-rated health is more strongly associated with mortality in men, but this is unlikely to be explained by differences in the nature of their physical health problems.

Aged↗
PubMed2003

Active life expectancy in people with and without diabetes.

BACKGROUND: The aim of the study was to investigate the feasibility of monitoring older people's health by measuring active life expectancy among older people with and without diabetes using routinely collected primary care data. METHODS: The study comprised the first five rounds of a routine health assessment of those aged 75 years and over belonging to a large Midlands general practice (list size 32,500). A nurse carried out the health assessments in the participant's home. Being active was defined as the ability to perform (without difficulty, help or use of aids) at least six of seven activities of daily living (ADLs). Mortality data were collected through the practice register together with regular linkage to information from the Office for National Statistics. Period health expectancies were calculated for those known or found to be diabetic through the health assessments and for non-diabetic individuals. RESULTS: Calculation of active life expectancies (ALE) was based on 2,474 persons (212 with and 2,262 without diabetes). At all ages, people with diabetes had lower life expectancy and spent fewer years active. The proportion of remaining life spent active was, however, similar for both groups at younger ages, but by age 85 years people with diabetes spent only 32 per cent of remaining life active compared with 42 per cent for those without diabetes. CONCLUSION: Annual health assessments of the over-75s in primary care together with linkage to mortality data provide a feasible method of monitoring older people's health, particularly for subgroups at greater risk of disability. At Strategic Health Authority or Primary Care Trust level these methods can monitor health needs, highlight health inequalities and evaluate intervention strategies.

Activities of Daily Living↗
PubMed2002

Factors associated with antidepressant treatment in residential care: changes between 1990 and 1997.

BACKGROUND: Depression is common among older people living in residential and nursing homes. Detection and treatment of late life depression may be sub-optimal in these settings. AIM: To report the changes in, and factors associated with, antidepressant use among residents in care homes in 1990 and 1997. METHOD: Censuses of those aged 65 years and over in any type of residential care in the county of Leicestershire, UK, on 27 November 1990 and 30 November 1997. Care staff were asked to complete an assessment form for each resident which included a rating of depression and use of antidepressants. RESULTS: The use of antidepressants increased from 11% (484/4415) in 1990 to 18.9% (777/4111) in 1997. Severity of depression as assessed by care staff, gender, younger age, better cognitive functioning, and use of other medications were consistently associated with antidepressant treatment. Antidepressant use was associated with better physical functioning (p = 0.001) in 1990 and frequency of falls in 1997 (p = 0.044). CONCLUSIONS: Increased use of antidepressants appears to be due to the wider range of antidepressant drugs available since 1990. However there is a need for better methods for care staff to detect depression in residents, and for appropriate action to be taken by those responsible for their medical management.

Aged↗
PubMed2002

Can routine information improve case finding of depression among 65 to 74 year olds in primary care?

BACKGROUND: The identification of groups with higher prevalence of major depression allows for more cost-effective investigation and treatment. OBJECTIVES: The aim of this study was to examine whether the identification of patient groups with a higher prevalence of depression through information routinely available in primary care can increase the efficiency of active case finding. METHODS: A cross-sectional two-stage survey was carried out of 2633 community residents between the age of 65 and 74 consisting of a structured interview with concurrent audit of general practice records. The 15-item geriatric depression scale (GDS-15) was used as a screening tool for depression. Individuals scoring > or =4 on the GDS-15 were offered a clinical interview using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN). RESULTS: There were 1912 (72.6%) participants in the first stage interview, of whom 134 had GDS-15 scores > or =4 and were invited to take part in the second stage. Of these, 90 participants (67.2%) agreed to the clinical interview. To detect one case of major depression, the number needing to be assessed was 63 for the whole sample. The number needing to be assessed was lower among those receiving antidepressants (nine), frequent GP attenders (12) and those living alone (32). CONCLUSION: Although depression is more common among various subgroups, our data show that the investigation of each high prevalence subgroup would detect only a minority of all cases in the total population. It is not possible to rely on active case finding in high prevalence subgroups for a high detection rate of depression in a practice population.

Aged↗
PubMed2002

The effect of older people's economic resources on care home entry under the United Kingdom's long-term care financing system.

OBJECTIVE: To determine how older people's economic resources affect their likelihood of care home entry in the United Kingdom. METHODS: In 1988, income, home ownership, and health data were collected for 1,425 people aged 75+. Participants received up to five subsequent health assessments before the study endpoint (1999), in which care home entry was also recorded. Care home entry was identified from death certificates for those who died. Using proportional hazards regression, the effect of home ownership and income on the risk of care home entry was estimated, controlling for predisposing, enabling, and need factors, and health service utilization. RESULTS: Age, living alone, activities of daily living restriction, cognitive impairment, poor/fair self-perceived health, and contact with services increased the risk of care home entry. Home ownership decreased it. Gender was not a significant predictor of care home entry once other factors were controlled for, and no significant effect was found for income. DISCUSSION: UK public authorities can require older home owners to use the value of their homes to pay for institutional but not community-based care, thus producing a financial incentive to place home owners in institutional settings. However, we find that home ownership reduces the likelihood of care home entry, suggesting that other factors dominate the decision process.

Activities of Daily Living↗