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Biomedical subjects

C MacArthur

Publications and source records attributed to C MacArthur.

At least 19 recordsLinked to original sources
PubMed2006

Factors associated with the use of complementary medicine and non-pharmacological interventions in symptomatic menopausal women.

BACKGROUND: Hormone replacement therapy is now thought to have serious adverse effects; consequently, many menopausal women are seeking to use complementary and alternative medicine (CAM), including non-pharmacological interventions (NPI), to alleviate symptoms. The prevalence and perceived effectiveness of CAM and NPI for ameliorating menopausal symptoms are not widely known and factors likely to predict CAM and NPI utilization for menopausal symptom management have not been comprehensively documented. OBJECTIVES: The objectives of this study were to (1) determine the prevalence of using CAM and NPI for menopausal symptoms; (2) describe the perceived effectiveness of CAM and NPI for symptom management; and (3) investigate lifestyle and demographic factors associated with CAM/NPI use among menopausal women with vasomotor symptoms. METHODS: Women aged 46-55 years were recruited via six socioeconomically diverse general practices. Participants completed a postal questionnaire that contained items relating to demographics, lifestyle factors, weight, height, exercise behavior, menopausal status, vasomotor symptoms and utilization and perceived effectiveness of a range of CAM/NPI for symptom management. RESULTS: Of 1,206 women who responded, 563 (47%) were symptomatic. The most commonly used CAM/NPI for symptom management were diet/nutrition (44.3%), exercise/yoga (41.5%), relaxation/stress management (27.4%) and homeopathic/naturopathic remedies (25.4%). Of women who used these interventions, large proportions reported them to be helpful. The characteristics that were independently associated with use of CAM/NPI were White ethnicity, being physically active, and not smoking. CONCLUSIONS: Many menopausal symptomatic women are using a wide range of CAM/NPI and report these to be effective, particularly those who are white, physically active and do not smoke.

Alcohol Drinking↗
PubMed2006

New postnatal urinary incontinence: obstetric and other risk factors in primiparae.

OBJECTIVE: To identify obstetric and other risk factors for urinary incontinence that occurs during pregnancy or after childbirth. DESIGN: Questionnaire survey of women. SETTING: Maternity units in Aberdeen (Scotland), Birmingham (England) and Dunedin (New Zealand). POPULATION: A total of 3405 primiparous women with singleton births delivered during 1 year. METHODS: Questionnaire responses and obstetric case note data were analysed using multivariate analysis to identify associations with urinary incontinence. MAIN OUTCOME MEASURES: Urinary incontinence at 3 months after delivery first starting in pregnancy or after birth. RESULTS: The prevalence of urinary incontinence was 29%. New incontinence first beginning after delivery was associated with older maternal age (oldest versus youngest group, OR 2.02, 95% CI 1.35-3.02) and method of delivery (caesarean section versus spontaneous vaginal delivery, OR 0.28, 95% CI 0.19-0.41). There were no significant associations with forceps delivery (OR 1.18, 95% CI 0.92-1.51) or vacuum delivery (OR 1.16, 95% CI 0.83-1.63). Incontinence first occurring during pregnancy and still present at 3 months was associated with higher maternal body mass index (BMI>25, OR 1.68, 95% CI 1.16-2.43) and heavier babies (birthweight in top quartile, OR 1.56, 95% CI 1.12-2.19). In these women, caesarean section was associated with less incontinence (OR 0.39, 95% CI 0.27-0.58) but incontinence was not associated with age. CONCLUSIONS: Women have less urinary incontinence after a first delivery by caesarean section whether or not that first starts during pregnancy. Older maternal age was associated with new postnatal incontinence, and higher BMI and heavier babies with incontinence first starting during pregnancy. The effect of further deliveries may modify these findings.

Adult↗
PubMed2006

Evaluation of Safe Kids Week 2004: age 4 to 9? It's booster seat time!

OBJECTIVE: To assess the effectiveness of a national one week media campaign promoting booster seat use. DESIGN: Pre-test, post-test design based on nationally representative random digit dialing telephone survey, with control for exposure to campaign. SETTING: Canada. SUBJECTS: Parents of children aged 4-9 years. INTERVENTIONS: During a one week campaign in May 2004, information on booster seat use was distributed via a national media campaign, retail stores, medical clinics, and community events. Information included pamphlets with guidelines for booster seat use, as well as a growth chart (designed by Safe Kids Canada) to assist parents in determining if their child should be using a booster seat. Assessing seat belt fit was described in detail on the growth chart. MAIN OUTCOME MEASURES: Knowledge, attitudes, and self-reported behaviors regarding booster seat use. RESULTS: Respondents in the group exposed to the campaign were twice as likely to report using a booster seat with lap and shoulder belt for their child (47%), compared to those in the pre-test (24%) and the unexposed (23%) groups (p<0.001). However, only small differences in general knowledge regarding booster seat use were found between the groups. CONCLUSIONS: A one week national media campaign substantially increased self-reported use of booster seats. Parents did not remember details of the campaign content, but did remember implications for their own child.

Accidents, Traffic↗
PubMed2003

Redesigning postnatal care: a randomised controlled trial of protocol-based midwifery-led care focused on individual women's physical and psychological health needs.

OBJECTIVES: To develop, implement and test the cost-effectiveness of redesigned postnatal care compared with current care on women's physical and psychological health. DESIGN: A cluster randomised controlled trial, with general practice as the unit of randomisation. Recruited women were followed up by postal questionnaire at 4 and 12 months postpartum and further data collected from midwife and general practice sources. SETTING: Thirty-six randomly selected general practice clusters in the West Midlands Health Region, UK. PARTICIPANTS: All women expected to be resident within recruited practices for postnatal care were eligible for inclusion. Attached midwives recruited 1087 women in the intervention and 977 in the control practice clusters. INTERVENTIONS: The systematic identification and management of women's health problems, led by midwives with general practitioner contact only when required. Symptom checklists and the Edinburgh Postnatal Depression Scale (EPDS) were used at various times to maximise the identification of problems, and individual care and visit plans based on needs. Evidence-based guidelines were used to manage needs. Care was delivered over a longer period. MAIN OUTCOME MEASURES: Women's health at 4 and 12 months, assessed by the Physical and Mental Component Scores (PCS and MCS) of the Short-Form 36 (SF-36) and the EPDS. Women's views about care, reported morbidity at 12 months, health service usage during the year, 'good practice' indicators and health professionals' views about care were secondary outcomes. RESULTS: At 4 and 12 months postpartum the mean MCS and EPDS scores were significantly better in the intervention group and the proportion of women with an EPDS score of 13+ (indicative of probable depression) was significantly lower relative to controls. The physical health score (PCS) did not differ. Health service usage was significantly less in the intervention group as well as reported psychological morbidity at 12 months. Women's views about care were either more positive or did not differ. Intervention midwives were more satisfied with redesigned care than control midwives were with standard care. Intervention care was cost-effective since outcomes were better and costs did not differ substantially. CONCLUSIONS: The redesigned community postnatal care led by midwives and delivered over a longer period, resulted in an improvement in women's mental health at 4 months postpartum, which persisted at 12 months and at equivalent overall cost. It is suggested that further research should focus on: the identification of postnatal depression through screening; whether fewer adverse longer term effects might be demonstrated among the children of the women who had the intervention care relative to the controls; testing interventions to reduce physical morbidity, including studies to validate measures of physical health in postpartum women. Further research is also required to investigate appropriate postnatal care for ethnic minority groups.

Adolescent↗
PubMed2002

Effects of redesigned community postnatal care on womens' health 4 months after birth: a cluster randomised controlled trial.

BACKGROUND: Much postpartum physical and psychological morbidity is not addressed by present care, which tends to focus on routine examinations. We undertook a cluster randomised controlled trial to assess community postnatal care that has been redesigned to identify and manage individual needs. METHODS: We randomly allocated 36 general practice clusters from the West Midlands health region of the UK to intervention (n=17) or control (19) care. Midwives from the practices recruited women and provided care. 1087 (53%) of 2064 women were in practices randomly assigned to the intervention group, with 977 (47%) women in practices assigned to the control group. Care was led by midwives, with no routine contact with general practitioners, and was extended to 3 months. Midwives used symptom checklists and the Edinburgh postnatal depression scale (EPDS) to identify health needs and guidelines for the management of these needs. Primary outcomes at 4 months were obtained by postal questionnaire and included the women's short form 36 physical (PCS) and mental (MCS) component summary scores and the EPDS. Secondary outcomes were women's views about care. Multilevel analysis accounted for possible cluster effects. FINDINGS: 801 (77%) of 1087 women in the intervention group and 702 (76%) of 977 controls responded at 4 months. Women's mental health measures were significantly better in the intervention group (MCS, 3.03 [95% CI 1.53-4.52]; EPDS -1.92 [-2.55 to -1.29]; EPDS 13+ odds ratio 0.57 [0.43-0.76]) than in controls, but the physical health score did not differ. INTERPRETATION: Redesign of care so that it is midwife-led, flexible, and tailored to needs, could help to improve women's mental health and reduce probable depression at 4 months' postpartum.

Adult↗
PubMed2002

Renal ultrasound findings and vesicoureteral reflux in children hospitalised with urinary tract infection.

AIMS: To determine the sensitivity, specificity, and predictive values of renal ultrasound findings for vesicoureteral reflux (VUR). METHODS: Retrospective review of the ultrasound and voiding cystourethrogram (VCUG) results of 162 children under 5 years of age admitted with their first episode of urinary tract infection (UTI) over a two year period. Ultrasound findings were considered suggestive of VUR if "dilatation of the pelvi-calyces", "dilatation of the ureters", or "dilatation of the collecting system" of one or both kidneys was reported. RESULTS: A total of 162 patients were eligible for inclusion (median age 85 days; 71 (44%) were female). The prevalence of VUR was 22%. Ultrasound findings were positive for VUR in 14 of 35 patients with confirmed VUR on VCUG, and positive in 30 of 127 patients without VUR on VCUG. Of 21 patients who had a normal ultrasound but showed VUR on VCUG, 14 had grade II reflux, five grade III reflux, and two grade IV reflux. The sensitivity and specificity of ultrasound in suggesting VUR were 40% and 76%, respectively. The positive predictive value of ultrasound in suggesting VUR was 32%; the negative predictive value was 82%. CONCLUSION: Renal ultrasound findings are neither sensitive nor specific for VUR in children with a first UTI.

Child, Preschool↗
PubMed2001

Conservative management of persistent postnatal urinary and faecal incontinence: randomised controlled trial.

OBJECTIVES: To assess the effect of nurse assessment with reinforcement of pelvic floor muscle training exercises and bladder training compared with standard management among women with persistent incontinence three months postnatally. DESIGN: Randomised controlled trial with nine months' follow up. SETTING: Community intervention in three centres (Dunedin, New Zealand; Birmingham; Aberdeen). PARTICIPANTS: 747 women with urinary incontinence three months postnatally, allocated at random to intervention (371) or control (376) groups. INTERVENTION: Assessment by nurses of urinary incontinence with conservative advice on pelvic floor exercises at five, seven, and nine months after delivery supplemented with bladder training if appropriate at seven and nine months. MAIN OUTCOME MEASURES: Primary: persistence and severity of urinary incontinence 12 months after delivery. Secondary: performance of pelvic floor exercises, change in coexisting faecal incontinence, wellbeing, anxiety, and depression. RESULTS: Women in the intervention group had significantly less urinary incontinence: 167/279 (59.9%) v 169/245 (69.0%), difference 9.1% (95% confidence interval 1.0% to 17.3%, P=0.037) for any incontinence and 55/279 (19.7%) v 78/245 (31.8%), difference 12.1% (4.7% to 19.6%, P=0.002) for severe incontinence. Faecal incontinence was also less common: 12/273 (4.4%) v 25/237 (10.5%), difference 6.1% (1.6% to 10.8%, P=0.012). At 12 months women in the intervention group were more likely to be performing pelvic floor exercises (218/278 (79%) v 118/244 (48%), P<0.001). CONCLUSIONS: A third of women may have some urinary incontinence three months after childbirth. Conservative management provided by nurses seems to reduce the likelihood of urinary and coexisting faecal incontinence persisting 12 months postpartum. Further trials for faecal incontinence are needed.

Adult↗
PubMed2001

Effects at age nine of maternal smoking in pregnancy: experimental and observational findings.

OBJECTIVES: To compare long term outcomes of a randomised controlled trial of anti-smoking education in pregnancy and to examine the same outcomes according to maternal pregnancy smoking behaviour. DESIGN: Follow up of the population included in the randomised controlled trial nine years later and of ex-smokers and non-smokers within the same hospital population. SETTING: A maternity hospital in Birmingham with follow up of children in schools and mothers at home. POPULATION: 1218 smokers recruited to the trial; also 191 ex-smokers at booking and 414 non-smokers throughout pregnancy. METHODS: Children were assessed individually by psychologists in schools, and mothers interviewed at home to obtain additional information relevant to cognitive development and growth. Information on smoking during pregnancy was obtained from mothers and obstetric data from computerised case-notes, both recorded immediately following delivery. MAIN OUTCOME MEASURES: Height, weight, IQ and neurological soft signs at 9.4 years. RESULTS: Differences in birthweight and length between the intervention and control groups were confirmed but no intervention-control differences were found at age 9.4 for weight, height, IQ or neurological soft signs. Differences were found for height and IQ according to mothers pregnancy smoking behaviour, but smoking did not remain an independent predictor after taking account of confounding factors. Alternative classifications of smoking behaviour, taking account of the gestation at stopping and mean cigarette consumption throughout pregnancy likewise showed no effect. CONCLUSIONS: The well established early hazards of smoking during pregnancy seem to be resolved by later childhood, with no evidence of direct long term effects on growth or cognitive functioning.

Birth Weight↗
PubMed2001

Obstetric practice and faecal incontinence three months after delivery.

OBJECTIVE: To determine whether obstetric and maternal factors relate to faecal incontinence at three months postpartum. SETTING: Maternity units in Aberdeen (Scotland), Birmingham (England) and Dunedin (New Zealand). POPULATION: All women who delivered during one year in the three maternity units. METHODS: Postal questionnaire at three months postpartum, to obtain information on faecal incontinence, linked to obstetric casenote data. MAIN OUTCOME MEASURES: Prevalence of faecal incontinence. RESULTS: 7879 questionnaires were returned, a 71.7% response rate. The prevalence of faecal incontinence was 9.6%, with 4.2% reporting this more often than rarely. Logistic regression, confined to primiparae, showed that forceps delivery was a predictor of an increased risk of symptoms (OR = 1.94, 95% CI 1.30 to 2.89) while vacuum extraction was not associated. Caesarean section was marginally associated with a reduced risk (OR = 0.58, 95% CI 0.35 to 0.97). Older maternal age, Indian sub-continent ethnic origin and body mass index 'not known' also showed significant associations. No associations were found for induced labour, duration of second stage labour, episiotomy, laceration or birthweight. CONCLUSIONS: Women delivered by forceps had almost twice the risk of developing faecal incontinence, whereas vacuum extraction was not associated with faecal incontinence at three months postpartum. Caesarean section appears to offer some protection.

Adult↗
PubMed2000

Relation between information and advice provision to male GUM clinic attendees and sexual orientation and ethnic group.

OBJECTIVES: To examine whether the provision of advice and information to male genitourinary medicine (GUM) clinic attendees was related to their reasons for attendance, ethnicity, or sexual orientation. METHOD: Cross sectional survey of men attending a large city centre GUM clinic. Data were collected using an anonymous subject completed questionnaire. RESULTS: Of the 302 men recruited, 72% described themselves as white and 85% reported only female sexual partners. Information and advice provision were generally found to reflect reason for attendance--for example, those attending with a concern about "an STD or urinary problem" were more likely to report advice and information on NSU/chlamydia, herpes, gonorrhoea, or syphilis than those attending without such concerns. For those attending with a concern about HIV less than half (42%) reported receiving advice and information about HIV. The reasons for attendance were found to vary with ethnicity (black men were more likely to attend for a "check up," and less likely to attend about HIV or with genital warts than white men) and sexual orientation (those with male partners were more likely to attend about HIV or hepatitis B than those with only female partners); there were corresponding variations in the provision of advice and information. CONCLUSIONS: The clinic was generally providing advice and information appropriate to the reasons for attendance and this reflected variations in such needs with ethnicity and sexual orientation. The provision of advice and information about HIV could be more comprehensive.

Adolescent↗
PubMed1998

What influences the uptake and early cessation of breast feeding?

OBJECTIVE: To examine obstetric, maternal and social factors associated with the uptake and early cessation of breast feeding and women's reasons for altering from breast to bottle feeding. DESIGN: Women who responded to a postal questionnaire on long-term postpartum health were contacted and asked to participate in a home-based interview. In addition to health problems, the interview obtained information on baby feeding and a number of social factors. Women were also asked to complete the Edinburgh Postnatal Depression Scale (EPDS). Obstetric and maternal data were obtained from maternity records. SETTING: Deliveries from a large maternity hospital in Birmingham. PARTICIPANTS: 906 women were interviewed at a mean of 45 weeks after delivery. FINDINGS: 63% of the women said they had breast fed, but 40% of these stopped within three months of delivery. Many of the women gave physical problems with lactation as reasons for stopping. The factors found to be predictors of early cessation were: return to work within three months of birth; regular childcare support from other female relatives, and a high EPDS score. Non-initiation of breast feeding was predicted by a different set of factors: multiparity; general anaesthetic (GA); and unmarried status. DISCUSSION AND CONCLUSION: Despite evidence of the benefits of breast feeding, this remains an unacceptable long-term option for many women, and for over one-third it is never attempted. Factors within the woman's social environment were found to influence early cessation. Women who had a GA during or immediately following labour and delivery were less likely to initiate breast feeding. IMPLICATIONS FOR PRACTICE: If breast-feeding incidence and duration are to increase, more attention should be paid to establishing early, successful breast feeding and countering the negative influences of factors within the social environment.

Adult↗
PubMed1998

Safer sex and social class: findings from a study of men using the 'gay scene' in the West Midlands region of the United Kingdom.

This article reports on associations between socio-demographic factors and safer sexual behaviour among gay and bisexual men in an English region. A cross-sectional survey using an anonymous self-complete questionnaire collected information on sexual behaviour and socio-demographic characteristics. All men using specified 'gay' venues and groups during the data collection period, were offered inclusion. Of the 858 men returning completed questionnaires, a greater proportion (30.3%) were from manual occupations when compared to previous United Kingdom studies. Of the whole sample, 64.6% reported either consistent condom use (safer sexual behaviour) or no anal sex during the last 12 months. No associations were found between age or ethnicity and consistency of condom use. Social class and employment status, however, were associated: those in manual occupations and those not working were more likely to be inconsistent in their condom use and students were more likely to be consistent. Inconsistent condom use was more likely to occur when having anal sex with 'boyfriends', and data on relationship length suggest that this may be occurring inappropriately in relation to risk of HIV infection. These findings suggest that social class and employment status may be related to safer sex practice.

Adolescent↗
PubMed1997

Pediatric aerodigestive foreign body injuries are complications related to timeliness of diagnosis.

Foreign body (FB) injury from aspiration or ingestion is a common pediatric health problem. Diagnosis relies on clinical judgment plus medical history, physical examination, and radiographic evaluation. A multi-institutional review of 1269 FB events revealed that 85% were correctly diagnosed following a single physician encounter. However, 15% of the children had an elusive diagnosis (>1 week), despite previous evaluation. Delays in diagnosis were seven times more likely to occur in aspirations than in ingestions. Secondary injuries (e.g., pneumonia and atelectasis) occurred in 13% of airway FBs but in only 1.7% of esophageal FBs. Plain radiographs were used in 82% of children, and special studies (e.g., fluoroscopy) in only 7%. We conclude that diagnosis of FB injury in children is frequently achieved at the initial evaluation but that continued surveillance by follow-up visits to health care facilities from parents and other caretakers is important, to reduce pulmonary injuries.

Adolescent↗
PubMed1997

Faecal incontinence after childbirth.

OBJECTIVE: To measure the prevalence and severity of postpartum faecal incontinence, especially new incontinence, and to identify obstetric risk factors. DESIGN: A cohort study with information on symptoms collected in home-based interviews and obstetric data from hospital casenotes. SETTING: Deliveries from a maternity hospital in Birmingham. PARTICIPANTS: Nine hundred and six women interviewed a mean of 10 months after delivery. MAIN OUTCOME MEASURES: New faecal incontinence starting after the birth, including frank incontinence, soiling and urgency. RESULTS: Thirty-six women (4%) developed new faecal incontinence after the index birth, 22 of whom had unresolved symptoms. Twenty-seven had symptoms several times a week, yet only five consulted a doctor. Among vaginal deliveries, forceps and vacuum extraction were the only independent risk factors: 12 (33%) of those with new incontinence had an instrumental delivery compared with 114 (14%) of the 847 women who had never had faecal incontinence. Six of those with incontinence had an emergency caesarean section but none became incontinent after elective sections. CONCLUSIONS: Faecal incontinence as an immediate consequence of childbirth is more common than previously realised, and medical attention is rarely sought. Forceps and vacuum extraction deliveries are risk factors, with no protection demonstrated from emergency caesarean section. Identification and treatment is a priority.

Adult↗
PubMed1997

Acceptability of clinics for sexually transmitted diseases among users of the "gay scene" in the West Midlands.

OBJECTIVES: To examine the acceptability of genitourinary medicine (GUM) clinics (for STDs) to homosexual and bisexual men. DESIGN: A cross sectional survey of men using "gay" venues and groups in the West Midlands region of the UK. Data were collected using an anonymous self-completed questionnaire. RESULTS: 848 completed questionnaires were returned. Two thirds of the respondents reported "safer" sexual behaviour. Those who had ever attended a GUM clinic (55%) differed little in their safer sexual behaviour from those who had never attended. The acceptability of the service was assessed using a range of indicators: the majority of the attendees had told a doctor, nurse or health adviser they have sex with men; and just over half had found all staff to be friendly, helpful or not homophobic. A quarter of attendees found talking about sexual matters difficult; these were less likely to have found the service acceptable. Over half (54%) of the study respondents had not been vaccinated against hepatitis B. Those who had been vaccinated were more likely: to have found the service acceptable; to have found talking about sexual matters easy; and to report safer sexual behaviour. CONCLUSIONS: These findings suggest that many homosexual and bisexual men who may need to use the GUM service have not done so. There is a need to improve the acceptability of the service and to further promote hepatitis B vaccination.

Adult↗