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Biomedical subjects

Charles Foster

Publications and source records attributed to Charles Foster.

8 recordsLinked to original sources
PubMed2005

Misrepresentations about palliative options and prognosis in motor neurone disease: some legal considerations.

If euthanasia were legalized, clinicians would be under a duty to explain to patients requesting euthanasia what the prognosis and palliative options were. Anecdotal evidence suggests that some patients suffering from motor neurone disease may request euthanasia because of a fear of choking to death. The literature indicates that with competent palliative care this is unlikely to occur. It is assumed, for the purposes of argument, that responsible clinicians would accordingly reassure patients that such a fear was unwarranted, and that such a reassurance would cause patients for whom choking was the main concern either to withdraw a request for euthanasia or not to make it in the first place. The legal consequences of both negligent and deliberate failure to represent the true prognostic and palliative situation are discussed. In the case of a deliberate failure, with the intention to induce the patient to consent to euthanasia, it is suggested that a verdict of murder would be ethically right. It is argued that such a failure is best regarded as an omission. The English law currently does not countenance the possibility of murder by omission. It is suggested that the distinction between acts and omissions, while sometimes convenient, can sometimes produce injustice, and that the distinction should not be allowed to prevent conviction for murder where this is clearly appropriate.

Airway Obstruction↗
PubMed2004

Changing the environment to promote health-enhancing physical activity.

Supportive environments have been used to change and influence health behaviours like smoking. While psychological and ecological theories and models demonstrate the possible influences of the environment on health-enhancing physical activity (HEPA), little is known about the effectiveness of the environmental interventions. This paper presents the results of a systematic review of studies that used environmental interventions to increase health-enhancing physical activity. Two groups of studies were found, studies that changed the physical environment by creating new HEPA facilities, policies and supporting mechanisms, and studies that used the elements of the environment as an active or sedentary 'point of choice', via educational materials to promote stair use. Environmental change studies showed a small increase on HEPA behaviour, but the relative impact of environment changes was not evaluated. A number of before and after studies have observed a weak effect of a simple environmental change to stimulate stair climbing while travelling or shopping. Current national policy has embraced the environment as an option for promoting health-enhancing physical activity, especially active travel, in spite of the lack of effectiveness data. It is recommended that existing or planned public health environment and HEPA initiatives should use appropriate evaluation methods to assess their efficacy and effectiveness. Further developmental research into the nature of the relationship of the environment to particular HEPA behaviours is strongly recommended before developing new environmental interventions.

Environment Design↗
PubMed2004

Environmental perceptions and walking in English adults.

STUDY OBJECTIVE: To examine the relation between adults' perceptions of the social and physical environment and their self reported walking behaviour. DESIGN: Cross sectional survey. SETTING: England. PARTICIPANTS: A national sample of 4265 adults aged 16-74 years. MAIN OUTCOME MEASURES: Self reported walking behaviour was categorised into two dichotomous variables: (a) any reported walking in past four weeks, (b) reported walking > or =150 minutes per week in the past four weeks. Perceptions of the social environment covered safety of walking alone and social support for walking. Perceptions of the physical environment covered attractiveness of local area for walking, access to shops, leisure centres, parks, cycle paths, and traffic density. MAIN RESULTS: In women, perceived safety of walking during the day (OR = 0.53; 95% CI: 0.31 to 0.88), and no shop within walking distance (OR = 0.72; 95% CI: 0.52 to 0.99) were associated with any reported walking occasions. Perceptions of the environment were not related to women walking > or =150 min/week. In men, having a park within walking distance was associated with walking > or =150 min/week (OR = 2.22; 95% CI: 1.18 to 4.35). No other significant associations were found. CONCLUSIONS: Women seem to be more concerned about walking for utility and in safety. Men are more likely to walk > or =150 min/week if they have access to a local park but their walking is not influenced by concerns about safety. Future research should focus on the relation between objective measures rather than perceptions of the environment and physical activity.

Adolescent↗
PubMed2004

A haplotype-based test of association using data from cohort and nested case-control epidemiologic studies.

Haplotype-based risk models can lead to powerful methods for detecting the association of a disease with a genomic region of interest. In population-based studies of unrelated individuals, however, the haplotype status of some subjects may not be discernible without ambiguity from available locus-specific genotype data. A score test for detecting haplotype-based association using genotype data has been developed in the context of generalized linear models for analysis of data from cross-sectional and retrospective studies. In this article, we develop a test for association using genotype data from cohort and nested case-control studies where subjects are prospectively followed until disease incidence or censoring (end of follow-up) occurs. Assuming a proportional hazard model for the haplotype effects, we derive an induced hazard function of the disease given the genotype data, and hence propose a test statistic based on the associated partial likelihood. The proposed test procedure can account for differential follow-up of subjects, can adjust for possibly time-dependent environmental co-factors and can make efficient use of valuable age-at-onset information that is available on cases. We provide an algorithm for computing the test statistic using readily available statistical software. Utilizing simulated data in the context of two genomic regions GPX1 and GPX3, we evaluate the validity of the proposed test for small sample sizes and study its power in the presence and absence of missing genotype data.

Algorithms↗