PubMed Health⌕ Search

Biomedical subjects

B O'Toole

Publications and source records attributed to B O'Toole.

At least 19 recordsLinked to original sources
PubMed2001

Are survey measures of medical care utilisation misleading? A comparison of self-reported medical care consumption with actual medical care utilisation.

A substantial over-estimate of medical care consumption cost was found when estimates from self-report data from an epidemiological study were compared to actual cost data extracted from administrative records. Even though the few subjects who were actually provided with two or more services in the two-week self-report period substantially under-reported their medical care consumption, a large net over-estimate of medical care consumption was produced by the self-report data. This finding has important implications for use of self-report data from surveys such as the Australian Bureau of Statistics (ABS) National Health Survey for estimating health service consumption. By combining epidemiological survey data from the Australian Vietnam Veterans Health Study (AVVHS), with data on actual medical care for which the Health Insurance Commission (HIC) or the Department of Veterans' Affairs (DVA) paid benefits, we were able to directly compare self-reported medical care consumption with actual medical care utilisation. The comparison revealed that veterans' self-reports were a valid measure of relative medical care consumption because those who reported care over the past two weeks were much more likely to have been recent consumers than those who did not. This relationship became even stronger if the comparison of self-report was extended to data on benefits paid beyond the two-week self-report period. However, the HIC and DVA data confirmed only 51% of veterans self-reporting medical care consumption during the past two weeks actually received a service.

Health Care Surveys↗
PubMed2000

Acute effects of bushfires on peak expiratory flow rates in children with wheeze: a time series analysis.

OBJECTIVES: To determine the effects of the January 1994 Sydney bushfire on evening peak expiratory flow rates (PEFR) in children with wheeze. METHODS: Children with a history of wheeze were enrolled in the longitudinal study and completed a daily asthma diary. We obtained daily air pollution, meteorological, pollen and alternaria data. We then used generalised estimating equation techniques to determine associations between the bushfire period and particulate matter less than 10 microns (PM10) and PEFR. RESULTS: The maximum daily PM10 level peaked at 210 ug/m3, which was nearly seven times the usual PM10 level for the rest of January and February 1994. There was no significant association between mean PM10 and PEFR (beta-coefficient = -0.009, p = 0.86). Children without bronchial hyper-reactivity had a significant negative association between PEFR and PM10 (beta-coefficient = -0.1029, p = 0.03). The bushfire period was not significant in any of the models. CONCLUSIONS: We did not find an association between the bushfire period or PM10 and evening PEFR, although in a subgroup of children without bronchial hyper-reactivity, a significant negative association was present between PM10 and evening PEFR. IMPLICATIONS: We conclude that the high levels of particulate pollution caused by the Sydney bushfires did not lead to any clinically significant reductions in PEFR in symptomatic children. Our results have implications for community risk communication during future bushfires.

Air Pollution↗
PubMed1998

A training strategy for personnel working in developing countries.

Throughout the world a common consensus has emerged that community based services offer the best prospect of meeting the needs of people with disabilities and their families. However the shift away from specialist centres and institutions has not been accompanied as yet by a reappraisal of the training required by personnel working in these new forms of services. This paper describes the training strategy which has been developed by the Community Based Rehabilitation Programme in Guyana, South America. This has three components. First, the identification of training needs of families and support workers, second, the production of video-based training packages on specific topics and third, the utilisation of available personnel to act as local tutors. This strategy has resulted in over 7000 CBR volunteers, health workers, teachers in mainstream schools, families and villagers having access to information and skills which otherwise they would be denied. An immediate priority in developing countries is to nurture the human resources required to develop and sustain this sort of training strategy and proposals for doing this are outlined.

Adult↗
PubMed1997

Neurodegenerative and other chronic disorders among people aged 75 years and over in the community.

OBJECTIVES: To assess age-related disease patterns in the older population in the community, especially the prevalence of neurodegenerative disorders and their association with systemic and vascular diseases. DESIGN: Cross-sectional, community-based study. SETTING: Area served by the Central Sydney Area Health Service, August 1991 to March 1994. SUBJECTS: 647 people aged 75 years or over, living in the community; 537 (83%) underwent medical assessment. OUTCOME MEASURES: Clinician diagnoses of chronic disease, including neurodegenerative disorders (cognitive and visual impairment, gait ataxia and slowing, dementia and Parkinson's disease); arteriopathy score; age-related trends; and correlations among diagnoses and arteriopathy score. RESULTS: Subjects had mean age of 81.0 years (range, 75-97). The most common diagnosis was arthritis (women, 73%; men, 68%), while the most common neurodegenerative diagnoses were gait ataxia (women, 57%; men, 42%), visual impairment (women, 40%; men, 45%) and cognitive impairment (women, 39%; men, 36%). Neurodegenerative diagnoses increased significantly in prevalence with increasing age, while most systemic diseases tended to decrease, although not significantly. Dementia was diagnosed in 92 subjects (17%), with Alzheimer's disease being the most common cause, but many having multiple causes. Significant correlations were found between neurodegenerative diagnoses and between the arteriopathy score and stroke, but not neurodegenerative diagnoses. CONCLUSIONS: The increase in comorbidities in the older population arises from an age-related increase in neurodegenerative disorders. These form a cluster suggesting a common aetiologic process which is not arteriopathic.

Aged↗
PubMed1997

Impact of an education program about domestic violence on nurses and doctors in an Australian emergency department.

OBJECTIVE: To increase the knowledge of nurses and doctors in an emergency department about the topic of domestic violence; to change any negative practices and attitudes toward victims; to increase knowledge of the referral processes for psychosocial aspects of domestic violence; and to increase knowledge of community resources for domestic violence victims. METHODS: Identical knowledge, attitude, and practice surveys were conducted with nurses and doctors in an emergency department before and after an educational intervention program about domestic violence. A matched-pair analysis of those respondents who answered both pretest and posttest surveys was conducted to measure the impact of the program on nurses and doctors. RESULTS: Nurses and doctors had a reasonable knowledge of the topic of domestic violence before the education program (correct answers: nurses, 61.6%; doctors, 63.4%). However, the program had a positive impact on their knowledge (correct answers posttest: nurses, 71.5%; doctors, 72.4%), with more significant changes for nurses than for doctors. The program affected both nurses' and doctors' attitudes (of 10 positive attitudinal statements: pretest, 7.9; posttest, 8.6). On both the pretest and posttest, nurses and doctors did not subscribe to a number of the myths about domestic violence that have been described in the domestic violence literature. These findings should be treated with caution because of the low response rates to the surveys from doctors (28.0%, n = 20) and nurses (53.0%, n = 48). DISCUSSION: Further research is needed into the beliefs and practices of nurses and doctors about domestic violence. The impact of this education program highlights the necessity for introducing training programs for health professionals on domestic violence problems.

Australia↗
PubMed1997

Help-seeking in Vietnam veterans: post-traumatic stress disorder and other predictors.

This study investigated factors predicting help-seeking from the Department of Veterans' Affairs (DVA) by Vietnam veterans. Data used were from a national Australian survey of Vietnam veterans' health (n = 641) conducted between July 1990 and April 1993. The survey involved current clinical assessments and retrospective questionnaires, supplemented with health and service records retrieved from the DVA and Army personnel files. Measures included the 1989-90 Australian Bureau of Statistics Health Survey questionnaire, and mental health, sociodemographic and operational deployment history questionnaires. For both current and lifetime diagnoses of post-traumatic stress disorder, a third of the veterans with the disorder had never obtained any health care entitlement from the DVA. Other than physical and mental problems, which accounted for the greatest proportion of the help-seeking odds, significant factors predicting help-seeking included factors such as: predeployment personality, combat exposure, the veterans' own attitudes towards their deployment, experiences during deployment, experiences during repatriation and membership of ex-service organisations. These findings on how post-traumatic stress disorder and other health problems relate to help-seeking patterns could help in developing prevention and care programs for stress disorder.

Australia↗
PubMed1996

Neurological signs, aging, and the neurodegenerative syndromes.

OBJECTIVES: To identify the prevalence of neurological signs said to be associated with "normal" aging in subjects 75 years and older. To examine the association of these signs with age, stroke, the neurodegenerative diagnoses (dementia, cognitive impairment, gait ataxia, gait slowing, and parkinsonism), and systemic diseases. DESIGN: Subjects participated in a standardized clinical history, examination, neurological evaluation, and neuropsychological assessment battery. A linear regression model that allowed the simultaneous consideration of multiple parameters was used to assess the independent contribution of age and disease to the presence of the signs. Correlations between the signs and age in the subgroup free of neurological diagnoses were performed. SETTING: Community-based study in Sydney, Australia. PARTICIPANTS: A random sample of 647 community-dwelling subjects older than 75 years. MAIN OUTCOME MEASURES: Standardized neurological examination in 537 subjects. RESULTS: With the exception of impaired vibration sense (beta = .009, P < .01), loss of upward gaze (beta = .005, P < .01), and bradykinesia (beta = .005, P < .01), all signs were associated with the neurodegenerative syndromes and stroke. Analysis of the subgroup free of neurological diagnoses confirmed these findings. Apart from impaired vibration sense of the thumbs (r = 0.22, P < .01) and gait instability (r = 0.20, P < .05), no significant associations with age were identified. CONCLUSION: It is not aging to which many neurological signs should be attributed, but rather to the neurodegenerative syndromes that accompany aging.

Aged↗
PubMed1996

Suicide trends in eight predominantly English-speaking countries 1960-1989.

Suicide rates between 1960 and 1989 were explored for eight predominantly English speaking countries with similar national characteristics. New World countries showed significant similarities but differed from Old World countries. The two North American (NA) New World countries showed more similarity to each other than the two Australasian New World countries. The NA countries showed an unique plateau in the 1980s for males aged 15-29 years. Old World males of all ages showed common rises, suggesting a partial sex-specific influence in the young. However, trends among the 15- to 19-year-olds were significantly different to trends among the 20- to 29-year-olds in both sexes suggesting a substantial youth-related contribution to the rises. Rates among 15- to 19-year-old females rose in the early 1960s, ahead of males but in parallel with rises among older females, suggesting part of the rise was sex- as opposed to age-related. Although rates among the 15- to 19-year-old females showed little change since 1970, this may be partly a function of sex-related improvements-observable in older females disguising unfavourable youth-related influences. Possible aetiological factors are suggested but remain speculative. Studies of other nations with common cultural characteristics may clarify trends and aetiological issues. Care should be taken to differentiate sex- from age-related influences.

Adolescent↗
PubMed1994

Determinants of condom use by Australian secondary school students.

PURPOSE: To identify factors that are associated with condom use to aid in the understanding of how to change the behavior of those young people who have sex without using condoms. METHODS: The article reports data from 932 sexually active grade 10-12 students from a sample of 72 public secondary schools in seven Australian states and territories. The data were collected using a cross-sectional, self-report questionnaire. RESULTS: Boys were more likely than girls to report that a condom was used the last time they had sex. For boys and girls, communication with a partner about avoiding infection with HIV/STDs, the belief that more peers use condoms, and a higher perceived risk of becoming infected with HIV/STDs were associated with using a condom, as was lower knowledge of STDs. The use of oral contraception and the unavailability of condoms were reported by the students as prominent reasons for non-use of condoms. Number of sexual partners in the past year and type of relationship with partner on the most recent occasion were not associated with condom use. CONCLUSIONS: Adolescents are more concerned with unwanted pregnancy than with disease prevention. School students more at risk are not more likely to take the necessary precautions to protect themselves from HIV/STDs.

Adolescent↗
PubMed1992

Reasons for encounter and diagnosed health problems: convergence between doctors and patients.

This study of 521 encounters in 25 urban general practices in Australia, compares both patient and doctor reported reasons for encounter (RFE) and diagnoses. Although doctors and their patients generally agreed on the overall distribution of RFE and diagnoses that arose, there was disagreement in at least 30% of paired comparisons within individual encounters. There was better agreement for RFE than for diagnoses. This may have been partly due to differences in the classification systems used. However, it suggests that diagnoses recalled by patients at later household interview are at best only a rough approximation of the diagnoses recorded by the doctor. These findings are important both for patient care and for the conduct of general practice morbidity research.

Attitude of Health Personnel↗
PubMed1991

How representative are patients in general practice morbidity surveys?

This study examined differences arising from the sampling of patients from general practice and household surveys. When 25 general practitioners, who agreed to participate in one week morbidity survey in inner western Sydney, were compared with all general practitioners (192) identified in the area, they were not significantly different in terms of socio-demographic variables and practice details. When the demographic characteristics of a sample of patients at 539 encounters with the 25 participating general practitioners were compared with those of a sample of 500 patients identified from a household survey who had consulted with any general practitioner within 2 weeks of the interview, few differences were found. Few significant differences were found in the reasons for encounter and diagnoses treated as recalled by the patients of the two groups. No differences were found in management--specifically prescription, investigations and referral--or with respect to health status. This study suggests that sampling of patients from randomly selected general practitioners can produce useful representative samples for studies of morbidity even when doctor participation rates are as low as 29%.

Adult↗
PubMed1991

Using general practitioners to measure community morbidity.

Randomly-selected patients drawn from randomly-selected General Practitioners (GPs) (two-stage cluster sample) were compared with a sample of the general population, who had visited a GP, selected using close approximations to standard household survey methods (area probability) of the Australian Bureau of Statistics. If GP patients drawn in this way resemble a random sample of the Australian community who have recently used GP services, then confidence should increase in this much cheaper method as a source of morbidity statistics. Interviews focused upon each person's last visit to the GP, with questions about reasons for attending, diagnoses and treatments, and various demographic items. In univariate analyses of 22 demographic items, 17 consultation items and 27 diagnoses and treatments, only five items were differently distributed between the GP patients and the area sample. Pairs of data items were also similar in the two groups. Items were examined using multidiscriminant analysis, to determine those that discriminated between the two groups and to calculate predicted group membership on the basis of these items. This analysis correctly classified only 56.7% of study subjects into their true group (GP patient or area sample) when based on items that were differently distributed between the groups, and 53.3% when all items were used, indicating that discrimination was only slightly better than chance. This result increases the confidence with which GP patients can be used to estimate levels of morbidity in the community if random selection is used to select GPs and if their patients are also randomly selected.

Bias↗
PubMed1988

A community-based rehabilitation programme for pre-school disabled children in Guyana.

The limitation of the traditional Institutionally-Based model of rehabilitation and the competing rationale for introducing a Community-Based model of services are examined. Problems with the World Health evaluation of CBR are discussed. The results of a CBR programme with 53 pre-school disabled children in rural areas of Guyana are presented. Quantitative and qualitative methods are combined to analyse the results. Portage and Griffiths pre/post test results showed significant improvement as a result of the training programme. Noticeable changes in the attitudes of the parents toward the child, the community and towards themselves are presented. The effective involvement of the community is analysed.

Child↗
PubMed1979

Evaluating student performance in an obstetrics and gynecology clerkship.

The development of a comprehensive evaluation system for an obstetrics and gynecology clerkship at the Unviersity of Utah is described and the results of two years experience using it are presented. Seven different measurement procedures were developed and used with 111 junior medical students including pre- and post-tests, oral examination, clinical performance ratings by residents, and ratings by faculty on oral and written presentations and participation in tutorial sessions. Learning gains as measured by pre-post test scores were significant at the 0.001 level. Only six of 37 correlations among the evaluation measures were significantly related at the 0.01 level; furthermore, little relationship could be found between measures of student achievement in cognitive as compared to clinical skill areas. The need for multiple sources of information on student performance in clerkships is discussed.

Clinical Competence↗
PubMed1979

A national survey of undergraduate teaching in obstetrics and gynecology.

Representatives of 114 academic departments of obstetrics and gynecology in North America completed a written questionnaire in 1977 designed to assess undergraduate educational programs. Respondents reported increases in numbers of departments and faculty per department and decreases in the length and number of students per clerkship in comparison with a 1968 survey. Small-group discussion, lecture, and professional patients were preferred instructional modalities of faculty and students. Evaluation procedures and faculty development activities are reported and discussed in relation to prior surveys of departments of obstetrics and gynecology.

Curriculum↗