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Biomedical subjects

D R Rutter

Publications and source records attributed to D R Rutter.

At least 19 recordsLinked to original sources
PubMed1992

Discomfort and pain during mammography: description, prediction, and prevention.

OBJECTIVE: To identify the nature of pain and discomfort experienced during mammography and how it can be ameliorated. DESIGN: Questionnaire survey before invitation for mammography and immediately after mammography. Responses before screening were related to experience of discomfort. SETTING: Health district in South East Thames region. SUBJECTS: 1160 women aged 50-64 invited routinely for screening; 774 completed first questionnaire, of whom 617 had mammography. 597 completed the second questionnaire. MAIN OUTCOME MEASURES: Reported discomfort and pain, comparisons of discomfort with that experienced during other medical procedures, qualitative description of pain with adjective checklist. RESULTS: 35% (206/597) of the women reported discomfort and 6% (37/595) pain. 10 minutes after mammography these figures were 4% (24/595) and 0.7% (4/595) respectively. More than two thirds of women ranked having a tooth drilled, having a smear test, and giving blood as more uncomfortable than mammography. The most important predictor of discomfort was previous expectation of pain (discomfort was reported by 21/32 (66%) women who expected pain and 186/531 (35%) who did not). Discomfort had little effect on satisfaction or intention to reattend. CONCLUSIONS: The low levels of reported pain and discomfort shortly after mammography and the favourable comparisons with other investigations suggest that current procedures are acceptable. Since two thirds of the women experienced less pain than expected health education and promotion must ensure that accurate information is made available and publicized.

Female↗
PubMed1990

Inequalities in pregnancy outcome: a review of psychosocial and behavioural mediators.

The purpose of this paper is to review the literature on psychosocial factors in pregnancy outcome and to present a model which attempts to integrate the findings theoretically. There are four sections. The first presents published data on the incidence of early childhood mortality and low birth weight. Changes over time and differences between countries are noted and attention is drawn to the marked inequalities between occupational groups in the British data. The second section reviews the evidence that a variety of psychosocial risk factors influence pregnancy outcome, notably social, emotional, cognitive and behavioural factors. The third section develops the theme of inequalities and examines theories which have been advanced to account for the differences in adult mortality. We argue that material deprivation goes some way towards explaining inequalities in pregnancy outcome, but that any proper account will have to explain the links between inputs and outcomes--the processes and mechanisms by which material deprivation is translated into observable mortality and morbidity. In the concluding section, we argue that some of the principal links are the psychosocial risk factors described in the second section, and we present a model which traces the pathways of mediation.

Female↗
PubMed1990

Alcohol training in south-east England: a survey and evaluation.

In 1982, the University of Kent at Canterbury introduced a multi-disciplinary diploma course in alcohol counselling and consultation. The purpose of the report which follows is to assess the existing range and level of alcohol services and training in south-east England against which the course was set up, and to appraise the course itself against its aims and objectives. The first part of the study was based on a questionnaire survey of senior administrators in Health and Social Services in London and the South East, and the examination of the course was based on student progress. The results from the first part of the study are bleak. Respondents believed that the majority of clients with alcohol problems were simply not detected, and a lack of resources to mount satisfactory training schemes was among the principal reasons. Only a minority of the organizations provided secondary-level training of any sort, and the majority placed alcohol problems at the bottom of their priorities for training and, by implication, for services overall. The results from the second part of the study were more encouraging. While there was little to suggest that students' knowledge and attitudes changed during the course, there were a number of small changes in behaviour. The most hopeful findings, however, came from students' and managers' perceptions, where one of the most positive outcomes of the course was a perceived growth in student maturity, confidence, and role security.

Alcoholism↗
PubMed1988

Do health beliefs predict health behaviour? A follow-up analysis of breast self-examination.

In a previous paper, we suggested that women who attended classes on breast self-examination showed significant improvements in behaviour, and that part of the reason was a change in their beliefs. Further analysis of our data confirms the original conclusion, and indicates that the perceived value of doing the behaviour is a more important predictor than perceived vulnerability to cancer.

Breast↗
PubMed1986

Do health beliefs predict health behaviour? An analysis of breast self-examination.

The purpose of this paper is to explore the relationships between health beliefs and health behaviour. The study we report was conducted as part of a national campaign to evaluate the benefits of breast self-examination in the early detection of breast cancer, and the purpose of our analysis was to test the Health Belief Model of Becker and his colleagues. Three groups of women were investigated--278 who accepted an invitation to attend self-examination classes and were taught the techniques in detail, 262 who declined the invitation and 594 controls to whom no classes were offered--and beliefs and self-reported behaviour were measured shortly before the classes took place and again a year later. The campaign, it emerged, produced marked changes in both beliefs and behaviour, but the relationships between beliefs and behaviour were much weaker than the model had led us to expect and accounted for no more than a quarter of the variance. Alternative models are considered, notably Fishbein and Ajzen's Theory of Reasoned Action, and the paper concludes with some suggestions for improving health campaigns.

Attitude to Health↗
PubMed1985

Language in schizophrenia. The structure of monologues and conversations.

Experimental research into language in schizophrenia has been guided traditionally by two main assumptions: that language disturbance is widespread among schizophrenic patients and easy to detect and measure, and that schizophrenia is fundamentally a cognitive disorder in which language disturbance is part of an inability or failure to regulate one's thoughts. However, recent findings have challenged both assumptions. Two experiments are reported here, the first based on monologues, the second on conversations, which were subjected to reconstruction and discourse analyses. Schizophrenic material is found to be harder to follow than normal, and is characterised by poor reference networks and inappropriate use of questions. While some of the results are specific to the schizophrenic group, others are found also in affective patients, but none is the product of formal thought disorder. The central problem lies less in cognition than in the social process of taking the role of the other.

Adolescent↗
PubMed1979

The reconstruction of schizophrenic speech.

A suggestion that schizophrenic speech may be harder to understand than normal speech was tested by a technique of reconstruction. Ten schizophrenic and ten normal passages were typed onto cards, one sentence per card. Each passage was then presented with the sentences in random order, and students were asked to reconstruct what they believed was the original order. Fewer correct strings of three or more sentences were achieved for the schizophrenic material than the normal material. It is concluded that there is a detectable abnormality in the structure of schizophrenic speech, but that it stems from the relationship between sentences rather than the content of individual sentences.

Humans↗
PubMed1978

Visual interaction in schizophrenic patients: the timing of looks.

Previous research has suggested that schizophrenic patients engage in very little Looking and eye-contact, at least in "personal" conversations. As yet, however, we know nothing about the precise timing of their Looks, even though this has important clinical implications. Data from three studies are presented and no evidence of abnormality is found. It is concluded that, taken together, findings from visual interaction suggest not that schizophrenic patients behave in a socially unskilled way as has sometimes been argued, but simply that they are embarassed by "personal" conversations and, like perfectly healthy people who are embarrassed, respond by averting the gaze.

Affect↗
PubMed1977

Visual interaction and speech patterning in remitted and acute schizophrenic patients.

Previous research has suggested that schizophrenic patients sometimes show abnormal patterns of visual interaction and speech. Several important questions remain, however, and the present study was designed for two purposes; to examine the behaviour of remitted patients; and to follow up a suggestion that acute patients show abnormalities only in personal encounters. Three groups of subjects, remitted schizophrenic patients, acute schizophrenic patients and a control group of psychiatrically normal chest patients, took part, and each subject held two conversations with a nurse, one about a 'personal' topic and one about a 'neutral' topic. Unexpectedly, the remitted and acute groups were both found to behave normally, in both conversations. Taken together with previous evidence, the findings thus confirmed that acute schizophrenic patients respond situation-specifically and sometimes behave normally, but no further interpretation of the data was possible since the manipulation of topic did not have the expected effects.

Acute Disease↗
PubMed1977

Speech patterning in recently admitted and chronic long-stay schizophrenic patients.

Several writers have suggested that schizophrenic patients show unusual formal, or non-content, patterns of speech. For reasons of methodology, none of their findings is easy to interpret, and important questions remain unanswered. In particular, we do not know how schizophrenic patients behave in free conversion, how their behaviour with another patient may differ from their behaviour with a psychiatrically normal partner, whether they show consistency across encounters, nor whether patients recently admitted to hospital differ from chronic long-stay patients. The first study was designed to examine the first three questions, by observing recently admitted schizophrenic patients in two free dyadic conversations, one with a schizophrenic partner and one with a psychiatrically normal partner, and comparing them with three control groups; depressive patients; patients suffering from neurotic or personality disorders; and psychiatrically normal chest patients. Consistently across their two encounters, schizophrenic subjects were found to behave similarly for the most part to all three control groups. The second study went on to examine the fourth question, by comparing recently admitted and chronic long-stay schizophrenic patients, and revealed no differences between the two groups. The investigation is discussed in the light of previous research, and it is suggested that a critical variable may be the setting and nature of the encounter in which the schizophrenic patient takes part.

Adolescent↗
PubMed1977

Thought disorder and the predictability of schizophrenic speech.

Previous research suggests that the predictability of speech in schizophrenic patients may be related to certain measures of thought disorder. Two uninterrupted passages of 200 words were taken from 25 randomly selected schizophrenic patients recently admitted to hospital and were 'Clozed' by students under both fourth- and fifth-word deletion. Thought disorder was measured by the Bannister-Fransella test, and the Cloze scores were found to be related neither to Intensity nor to Consistency.

Adult↗
PubMed1976

History-taking for medical students. I-Deficiencies in performance.

A videotape analysis of histories conducted by 50 senior medical students was carried out to assess their history-taking skills. As predicted, serious deficiencies (similar to those evident in inexperienced medical students) were found. It is argued that traditional methods of clinical training fail to equip medical students with adequate history-taking skills. They should be given a more appropriate history-taking scheme, the opportunity to practice this under conditions of direct observation within strict time-limits, and detailed feedback about their performance.

Education, Medical, Undergraduate↗
PubMed1976

History-taking for medical students. II-Evaluation of a training programme.

Two experiments designed to evaluate a programme for training medical students in history-taking skills were carried out. Results of the first indicate that students who underwent the programme reported almost three times as much relevant and accurate information after a test interview as those who received only traditional training. Results of the second experiment suggest that most of the programme's effect is attributable to discussion of a printed handout which presents the student with a detailed scheme for taking histories.

Education, Medical, Undergraduate↗
PubMed1976

Visual interaction in recently admitted and chronic long-stay schizophrenic patients.

Several reports have suggested that schizophrenic patients engage in very little Looking and eye-contact. However, previous work, much of it methodologically unsatisfactory, has been based almost always on the clinical psychiatric interview, with the result that several important questions remain unanswered. In particular, we do not know how schizophrenic patients behave in free conversation, how their behaviour with another patient may differ from their behaviour with a psychiatrically normal partner, nor even whether they show individual consistency across encounters. The first study was designed to examine these questions, by observing recently admitted schizophrenic patients in two free dyadic conversations, one with a schizophrenic partner and one with a psychiatrically normal partner, and comparing them with three control groups: depressive patients; patients suffering from neurotic or personality disorders; and psychiatrically normal chest patients. The second study went on to test whether the early descriptions of gross abnormality may be more appropriate to chronic long-stay patients than to recently admitted patients, and the design consisted of a comparison between the two groups. The first study revealed a quite unexpected pattern of results. Consistently across their two encounters, schizophrenic subjects behaved similarly for the most part to all three control groups, normal and abnormal alike. Moreover, the few differences which did emerge conflicted sharply with previous findings, including the writer's, and were no more marked in patient-patient than patient-normal encounters. The second study revealed no differences between chronic long-stay and recently admitted schizophrenic patients. It is suggested that the differences in findings between the present two studies and previous reports are most likely to be attributable to differences in verbal content: schizophrenic patients show abnormalities of visual interaction when talking about personal matters, but behave quite normally when the topic is not of immediate personal relevance.

Chronic Disease↗