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Biomedical subjects

C Bowie

Publications and source records attributed to C Bowie.

At least 19 recordsLinked to original sources
PubMed2006

Using tuberculosis suspects to identify patients eligible for antiretroviral treatment.

SETTING: A district in rural sub-Saharan Africa with a recently introduced antiretroviral (ARV) programme. The population has high human immunodeficiency virus (HIV) prevalence and high tuberculosis (TB) incidence. OBJECTIVE: To determine the prevalence of HIV and acquired immune-deficiency syndrome (AIDS) related symptoms in people presenting with chronic cough who are not diagnosed with TB. DESIGN: A cross-sectional survey of TB suspects. METHODS: Patients with chronic cough were recruited from out-patient facilities. After standard diagnostic procedures and providing informed consent, they received counselling and testing for HIV, and were interviewed and examined with respect to staging criteria for HIV/AIDS. Suspects were followed up for 3 months after the end of the recruitment period to allow for delayed diagnosis of TB. RESULTS: Of 145 suspects, 79% had not been diagnosed with TB by the end of the follow-up period. Of these, 108 (95%) agreed to HIV testing and 61 (56%) were HIV-positive. More than half of these were eligible for ARV treatment (Stage III or IV disease) under national programme criteria. CONCLUSION: Established chronic cough clinics are a useful setting for recruitment of patients to ARV clinics. Attendees should be offered HIV testing and simple clinical screening to identify those who should be referred for ARV treatment.

Adult↗
PubMed2001

Six-year follow-up study of cognitive and functional status across the lifespan in schizophrenia: a comparison with Alzheimer's disease and normal aging.

OBJECTIVE: Follow-up studies of cognitive functions of poor-outcome (long-term institutionalized) elderly patients with schizophrenia have demonstrated deterioration over time, while stable cognitive functions over time have been reported for younger, better-outcome schizophrenic patients. This study examined whether cognitive changes in elderly schizophrenic patients with a history of long-term institutional stay extended to institutionalized younger patients. The rate of decline was compared to changes associated with Alzheimer's disease. METHOD: Patients with schizophrenia (N=107) age 20-80 years were followed over 6 years and assessed with the Clinical Dementia Rating and the Mini-Mental State Examination. The schizophrenic subjects age 50 and older were compared to 136 healthy comparison subjects and 118 Alzheimer's disease patients age 50 and older who were assessed over a similar follow-up period. RESULTS: There was a significant age group effect on the magnitude of cognitive decline for the schizophrenic subjects, with older subjects experiencing greater levels of decline over the follow-up. Neither the healthy individuals nor the Alzheimer's disease patients demonstrated similar age-related differences in the magnitude of cognitive change over the follow-up, with healthy comparison subjects showing no change and Alzheimer's disease patients manifesting decline regardless of age at the initiation of the follow-up. CONCLUSIONS: Institutionalized schizophrenic patients demonstrated an age-related pattern of cognitive change different from that observed for Alzheimer's disease patients and healthy individuals. The cognitive and functional status of these schizophrenic patients was fairly stable until late life, suggesting that cognitive change may not be occurring in younger patients over an interval as long as 6 years.

Adult↗
PubMed2000

Estimating the "avoidable" burden of disease by Disability Adjusted Life Years (DALYs).

The World Bank's Global Burden of Disease Study pioneered the use of Disability Adjusted Life Years (DALYs). In this paper we distinguish between the total and the "avoidable" burden of disease. We identify different ways of measuring DALYs: incidence-based DALYs are appropriate where the means of reducing the burden of disease is by prevention; prevalence-based DALYs are appropriate when a disease cannot be prevented but effective treatment is available. The methods of estimating each are explained and we describe how we have applied these methods to seven causes of death and disability in the South and West Region. We discuss the relevance of this work for monitoring the health of populations and deciding how best to use scarce resources to improve health.

Age Factors↗
PubMed2000

Clinicians' attitudes to recruitment to randomised trials in cancer care: a qualitative study.

OBJECTIVES: To explore attitudes to and problems experienced with recruitment into randomised trials in cancer care. METHODS: In-depth semi-structured interviews with a purposive sample of 20 hospital clinicians in the South West of England identified from 192 participants in a larger postal survey. Interviews were recorded on audiotape and fully transcribed. Data were analysed by comparing transcripts and describing emergent themes. RESULTS: Clinicians do not always find it easy to identify key randomised trials in their area of interest. Even when they identify those trials in which they would like to participate, they are not always able to recruit patients. Although recruitment can be hindered by the time and administration involved and the resources needed, the attitudes of clinicians to research in general, the design of randomised trials, clinicians' concerns regarding individual patients and patients' preferences for different treatments also present major barriers. Other factors of concern include the imposition of strict eligibility criteria and the expense and complexity of monitoring and follow-up. CONCLUSION: Barriers to recruitment depend on the clinicians' individual situations and on a complex combination of factors. Action is needed to promote awareness of randomised trials under way, to ensure that trials address issues of importance, are acceptable to patients and clinicians, and that practical support is provided for participating centres.

Attitude of Health Personnel↗
PubMed1998

The effect of a lindane and mercury polluting incident on the health of a community: the Somerton Health Survey.

OBJECTIVES: This study sought to identify possible illnesses of people exposed to lindane and methyl mercury following a pollution incidence in Somerton, Somerset, UK. METHODS: A self-administered questionnaire survey was posted to 1500 residents in three selected areas of Somerton to identify symptoms of possible illness over a 3 month period. RESULTS: There was a 74% response rate. People living near the stream had higher levels of reported mental symptoms and itching skin than in controls. Poisoning as the cause of the mental symptoms was excluded as the individuals had normal blood levels of lindane or mercury. Other symptoms were no higher in one area than another or from one time period to another. CONCLUSIONS: The survey, using controls in time and space, was able to explore, the pollution incident's contribution to the toxicity of residents and how this related to mental symptoms experienced by the residents.

Air Pollutants↗
PubMed1997

Estimating the burden of disease in an English region.

BACKGROUND: Health Authorities seeking to make appropriate investments in health care require information about the nature of the burden of disease in their populations. The World Bank instrument called DALY-Disability Adjusted Life Year-has been used in the South and West Region to measure this burden. METHOD: The burden of disease caused by a selection of diseases has been calculated using DALYs, which combine premature mortality and disability. An estimate of the total burden has been estimated by ICD chapter. RESULTS: Premature mortality accounts for 52 per cent of the burden of disease and disability 48 per cent. Mental illness, for which its DALY value is largely derived from disability not premature mortality, contributes the third largest component of the total burden, after heart disease and cancer. DISCUSSION: DALYs can be calculated using UK data, and, with an appreciation of the theoretical issues which surround the calculations, can be used to describe the burden of disease in a population. Although designed to assist investment decisions in developing countries, the DALY is likely to be valuable in established market economies.

Algorithms↗
PubMed1996

A case-control study of cancer of the prostate in Somerset and east Devon.

A case-control study in Somerset and east Devon was undertaken to investigate possible risk factors for prostatic cancer. A total of 159 cases, diagnosed at Taunton. Yeovil and Exeter hospitals between May 1989 and May 1991, were identified prospectively and interviewed with a structured questionnaire. A total of 161 men diagnosed with benign prostatic hypertrophy and 164 non-urological hospital controls were given identical questionnaires. The questionnaire covered a wide range of factors identified from previous studies, but the central hypotheses for this study related to diet (fat and green vegetables), sexual activity and farming as an occupation. This study found no association between farming and risk of prostatic cancer (odds ratio = 0.74, 95% confidence interval 0.46-1.18), nor with sexual activity as measured by number of sexual partners (chi-squared test for trend P = 0.52). A history of sexually transmitted disease was not significantly associated with prostatic cancer, but the numbers involved were very small and the odds ratio of 2.06 (0.38-11.2) is consistent with the hypothesis. A range of questions aimed at eliciting dietary fat intake produced no significant associations, although meat consumption showed increasing risk with increasing consumption (test for trend P = 0.005). Increased consumption of leafy green vegetables was associated with lower risk, but not significantly so (test for trend P = 0.16). As expected with so many factors investigated, some statistically significant associations were found, although these can only be viewed as hypothesis generating in this context. These included apparent protective effects of circumcision and high fish consumption.

Aged↗
PubMed1995

Consulting the public about health service priorities.

Consulting the public is an important component of commissioning health services. Somerset Health Authority has devised a method of consultation using eight focus groups meeting three times a year. Each group consists of 12 people, and together the groups are demographically representative of Somerset's population. The groups are asked about issues that are concerning the health authority, and their views have influenced health authority decisions. Each group is given some background information before the meeting, together with more information at the meeting. The discussions are tape recorded and analysed for qualitative information, but the groups are also asked to score certain priorities. The groups have been found to be representative, valid, and focused on community rather than individual values. Health authorities wanting to know the values people attach to health services should adopt this qualitative approach to consultation.

Adolescent↗
PubMed1994

Radon and health--an update.

BACKGROUND: The National Radiological Protection Board (NRPB) estimated in 1990 that radon causes 5 per cent of lung cancer in the United Kingdom. The estimate was not based on direct evidence. Since then a number of epidemiological studies have been reported. In addition, various policies have been formulated and some implemented, including the mounting of public campaigns to reduce radon in houses in parts of the United Kingdom. METHODS: A review of the scientific literature, policy documents and results of the campaigns has been undertaken. RESULTS: New data on miners support previous evidence that radon, at the levels found in mines, does cause lung cancer. The one study to add to the two previous case control studies looking at domestic radon tips the scales slightly towards radon being incriminated in homes as well. The effect of smoking, a multiplicative or additive risk with radon, is still unclear. Radon can be calculated to cause up to 383 lung cancer deaths per year in the five currently designated 'radon affected' areas. Approximately 287 of these deaths will be in cigarette smokers, and the most effective way for smokers exposed to radon to reduce their lung cancer risk is to stop smoking. CONCLUSION: Evidence of the risk from residential radon is still insufficient to justify the current NRPB advice. If it were, a much more effective radon campaign would be needed. Such a campaign would concentrate on reducing lung cancer in people by tackling both radon exposure and cigarette smoking, rather than simply reducing radon in houses.

Cohort Studies↗
PubMed1994

The fundholding fandango.

General practitioner fundholding allows flexible use of resources at the coal-face, provides incentives to alter practice such as prescribing within cash limits and forces hospitals to be more responsive to general practitioner demands. However, the additional administrative costs both in time and money, the fragmentation of purchasing power compounded by a lack of expertise and experience in contracting, and the poor information and financial systems which exist in the National Health Service are severe constraints. A suggested way forward is to delegate responsibility for running the scheme, including the contracting and billing, to district health authorities offering more flexible budgets to all practices and extending the scheme as local information systems allow. This will reduce fragmentation of purchasing power and administrative costs and re-establish local accountability. It will also give the general practitioner more time to see and treat patients, who will see the system as being fairer.

Budgets↗
PubMed1993

Evidence of unmet need in the care of severely physically disabled adults.

OBJECTIVE: To identify unmet needs in the care of severely disabled people aged 16-64. DESIGN: Detailed personal interview and physical assessment of physically disabled adults; personal or telephone interview with carers. SETTING: Somerset Health District. SUBJECTS: 181 severely disabled adults and their carers. MAIN OUTCOME MEASURES: Independence in activities of daily living; identity of requirements for assessing communication disorders; appropriate provision of services and allowances. RESULTS: 53 (29.3%) of the 181 disabled subjects had unmet needs for aids to allow independence in activities of daily living-namely, 43% of subjects (41/95) with progressive disorders and 14% of subjects (12/86) with non-progressive disorders. The prevalence of unmet need was higher among subjects whose sole regular professional contact was with health services personnel (48 (40.3%) of 119 subjects). Only 18 (31.6%) of the 57 subjects with communication disorders had ever been assessed by a speech therapist. CONCLUSIONS: This study shows that the needs of severely physically disabled adults in the community--especially those with progressive disorders--are being monitored inadequately by health professionals.

Activities of Daily Living↗
PubMed1992

A methodology for collecting outcome measures for common hospital conditions.

An eight-month prospective analysis of routinely collected hospital data with 24-week follow-up of mortality and morbidity was carried out at two district general hospitals in Somerset Health District, to test the feasibility of collecting useful and valid outcome measures for two common hospital conditions, strokes and fractured hips. Data were collected on 163 consecutive admissions with a primary diagnosis of stroke (83 cases) or fractured hip (80 cases). At 24 weeks, 38 patients with stroke had died (mortality ratio 46 per cent, 95 per cent C.I. = 35.3-56.7 per cent) and 11 with fractured hip had died (mortality ratio 14 per cent, 95 per cent C.I. = 6.4-21.6 per cent). Seven patients (four with fractured hip and three with stroke) died after 24 weeks and before responding to the NHP questionnaire. One stroke patient could not be traced. Nottingham Health Profiles were received from 106 patients (41 with stroke and 65 with fractured hip). Both groups of patients had problems with physical mobility and lack of energy. Patients with fractured hips were more likely to complain of pain. It is concluded that the methods used to collect outcome measures in this study are widely applicable to other conditions, but the interpretation and comparability of the results require the collection of similar data elsewhere.

Aged↗