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Biomedical subjects

E M Alder

Publications and source records attributed to E M Alder.

14 recordsLinked to original sources
PubMed2002

What predicts poor collection of medication among children with asthma? A case-control study.

Compliance with asthma medication is recognised to be a problem. Acquisition of medication is the first step towards compliance. Factors predicting poor collection of prophylactic medication were investigated. A case/control study was conducted. Cases were children who had had at least two consultations for poorly controlled asthma in 1 yr and collected prescriptions of prophylactic medication irregularly. Controls were children whose prescriptions were collected as instructed. Levels of knowledge about asthma and asthma medication were high in both groups. Parents of cases were more likely to perceive their child's asthma to be moderate or severe and more likely to report that their child's asthma was not well controlled. They reported more night-time symptoms, exercise symptoms and school absence. Parents of cases were less likely to report that administering inhalers was part of the evening routine. They were less likely to perceive their child's prophylactic medication to be very effective and more reluctant to administer prophylactic medication. Some parents may decide to undertreat their children, although lack of organised routine may contribute to poor compliance. Parents need guidance on interpreting symptoms and support in establishing routines for the administration of medication.

Administration, Inhalation↗
PubMed2002

The RCP's 'Three Key Questions' for asthma: review of practical use.

Assessment tools are a vital component of chronic disease management. The Royal College of Physicians has developed a patient-focused outcome measure for the treatment of asthma, the 'Three Key Questions'. However, in a study investigating the goals of people with asthma, several issues related to the tool emerged. Forty-seven adults of a range of ages and asthma severity but with no significant co-morbidity were interviewed. It emerged that the outcome measure may be subject to recall bias. Also, symptom reports may be conflated if daytime symptoms also occur with activity. 'Interference with activity' is a subjective term the interpretation of which varies considerably. Changes in the level of activity undertaken may be reported rather than changes in symptom severity. The 'Three Key Questions' are not fully patient-centred because they assess the presence of symptoms rather than their importance to the individual. The use of the 'Three Key Questions' as an outcome measure may not allow valid comparisons to be made between settings.

Activities of Daily Living↗
PubMed2001

Rattling the plate--reasons and rationales for early weaning.

To identify a range of attitudes and beliefs which influence the timing of introduction to solid food, five focus group discussions were undertaken within a maternity hospital setting. These sessions explored early feeding behaviour, stimuli to changing feeding habits and subsequent responses in 22 primiparous and seven multiparous mothers (mean age 27.0+/-4.8 years) with babies aged 8-18 weeks (mean age 13.0+/-4.2 weeks). One-third of the participants had introduced solid food to their infants (mean age of introduction 11.6 weeks, range 2-16 weeks). Mothers believed that the introduction of solids was baby led and initiated by some physical characteristic or behavioural action of the infant. All mothers were aware of current recommendations to avoid the introduction of solid food until 4 months. Few knew why this should be and concepts of long-term ill health were difficult to conceptualize. The conflict between rigid feeding guidelines and flexible advice from supportive health professionals created confusion over the importance of good weaning practices. The current findings highlight issues relevant to the introduction of solid food, and provide a foundation for further research which can identify the relative importance of these factors and provide a rationale for the design of contemporary intervention strategies.

Adult↗
PubMed2001

A survey of information given by health professionals, about bottle feeding, to first-time mothers in a Scottish population.

OBJECTIVE: To assess mothers' perception of information given to them about bottle feeding. DESIGN: Survey, as part of a longitudinal study of professional support given to infant feeding mothers. Data were analysed from postal questionnaires completed at 34 weeks gestation and one month postnatally. SUBJECTS: Every woman over 16 years expecting her first baby in an uncomplicated pregnancy, in two Scottish regions, was sent an antenatal questionnaire over an eight month period during 1998. This report considers respondents over 23 years of age, of whom there were 365 (51% response rate). Of these, 296 (81%) completed the subsequent questionnaire at one month postnatally. RESULTS: Fewer than 50% of women reported being given information about sterilising equipment, making feeds and offering the right quantities, before the birth of their baby. Of women considering bottle feeding only 42% had been given any information on sterilising equipment before their baby's birth. Of women who had begun to breastfeed but were giving bottle feeds at one month postnatally, fewer than 40% had been given information on bottle feeding antenatally, and less than 56% postnatally. CONCLUSION: In a study of 365 mothers of 23 years and over most women reported having little or no information about bottle feeding. Women who intended to bottle feed reported receiving more information than those intending to breastfeed. Those giving bottle feeds at one month reported that they received more information than those exclusively breastfeeding, but low levels of information giving were recalled overall.

Adult↗
PubMed2000

Reviewing audit: barriers and facilitating factors for effective clinical audit.

OBJECTIVE: To review the literature on the benefits and disadvantages of clinical and medical audit, and to assess the main facilitators and barriers to conducting the audit process. DESIGN: A comprehensive literature review was undertaken through a thorough review of Medline and CINAHL databases using the keywords of "audit", "audit of audits", and "evaluation of audits" and a handsearch of the indexes of relevant journals for key papers. RESULTS: Findings from 93 publications were reviewed. These ranged from single case studies of individual audit projects through retrospective reviews of departmental audit programmes to studies of interface projects between primary and secondary care. The studies reviewed incorporated the experiences of a wide variety of clinicians, from medical consultants to professionals allied to medicine and from those involved in unidisciplinary and multidisciplinary ventures. Perceived benefits of audit included improved communication among colleagues and other professional groups, improved patient care, increased professional satisfaction, and better administration. Some disadvantages of audit were perceived as diminished clinical ownership, fear of litigation, hierarchical and territorial suspicions, and professional isolation. The main barriers to clinical audit can be classified under five main headings. These are lack of resources, lack of expertise or advice in project design and analysis, problems between groups and group members, lack of an overall plan for audit, and organisational impediments. Key facilitating factors to audit were also identified: they included modern medical records systems, effective training, dedicated staff, protected time, structured programmes, and a shared dialogue between purchasers and providers. CONCLUSIONS: Clinical audit can be a valuable assistance to any programme which aims to improve the quality of health care and its delivery. Yet without a coherent strategy aimed at nurturing effective audits, valuable opportunities will be lost. Paying careful attention to the professional attitudes highlighted in this review may help audit to deliver on some of its promise.

Attitude of Health Personnel↗
PubMed1999

Psychological effects of hormone replacement therapy: a comparison of tibolone and a sequential estrogen therapy.

Hormone replacement therapy (HRT) is effective in alleviating vasomotor symptoms but the effect on psychological symptoms is less clear. This study aimed to compare the psychological effects of two regimens of HRT in perimenopausal women in a randomized, initially double-blind, controlled trial. Thirty-eight women reporting climacteric symptoms were randomly allocated into either oral conjugated equine estrogen 0.625 mg daily plus progestogen (norgestrel) 150 micrograms for the last 12 days of each 28 day cycle, or tibolone 2.5 mg/day for 28 days. They were assessed using standardized psychological assessments. There were no significant differences in changes from baseline between the two types of therapy. For both groups combined there were significant improvements compared with baseline in vasomotor symptoms in the first month, plus anxiety, sleep, memory and somatic dysfunction by the second and third months, but not in scores of depression. Log linear analysis of weekly scores showed that depression scores were significantly related to improvement in vasomotor scores independent of type of therapy and time on HRT. Memory problems were related to vasomotor symptoms independent of depression. No difference between the two types of therapy was found, nor any direct effect of HRT on anxiety or depression. The results support the domino theory, suggesting that psychological improvement follows alleviation of vasomotor symptoms.

Aged↗
PubMed1995

Tibolone and climacteric symptoms.

Tibolone (Livial) has advantages over other forms of hormone replacement therapy (HRT); it is easy to use and does not induce withdrawal bleeding in postmenopausal women. The evidence for the effect of tibolone on climacteric symptoms is reviewed and shows that tibolone is effective in reducing vasomotor symptoms and vaginal dryness. Tibolone's effect on a range of other symptoms such as headache and insomnia is unclear. There are reports that tibolone improves mood and libido but much of this research is methodologically flawed. Methodologically sound research is required to investigate tibolone's effect on mood and libido; such a study is in progress.

Climacteric↗
PubMed1992

Do women want a once-a-month pill?

The attitudes of women of reproductive age in Scotland, Romania and Slovenia to the idea of a contraceptive pill which is taken only once each month or only when menses are delayed was investigated. In all three centres, the great majority of women felt positive towards the idea of a once-a-month pill which inhibited ovulation and greater than 50% found a pill which inhibited or interfered with implantation an acceptable idea. Only 24% of women in Scotland were attracted to the idea of a pill which was taken only if menstruation was delayed by 1 or 2 days, that is a pill which would cause an abortion, while in contrast 58% of women in Slovenia and 80% in Romania thought that such a method of controlling fertility would be acceptable. Attitudes were not related to age, social class or marital status but were influenced by religious belief and in Scotland by a history of abortion. In countries where the availability of contraception is limited and abortion is common, women would seem to welcome another method of fertility regulation--even one which disrupts the very early stages of pregnancy.

Abortion, Induced↗
PubMed1989

Sexual behaviour in pregnancy, after childbirth and during breast-feeding.

Sexual and marital relationships change throughout marriage and the transition to parenthood can be seen as a psychosocial crisis. Recent studies do not support the finding of Masters and Johnson (1966) that there is a mid-trimester rise in sexual responsiveness. Sexual behaviour decreases towards the end of pregnancy and a number of studies have found that in the majority of mothers there is only a slow return to pre-pregnancy levels in the first postnatal year. Some of the factors influencing the rate of return are discussed. Breast-feeding is important because of the hormonal changes it produces and it has been said to stimulate sexual feelings in both mother and baby. There is some evidence that breast-feeding has an adverse effect on sexuality in the first postnatal year. It is not clear whether this could be related to differences in hormone levels or differences in feeding behaviour. Fatigue and contraception have largely been ignored in studies of factors influencing postnatal sexual behaviour. Women who went on to breast-feed were found to be very similar on antenatal measures of sexual behaviour to those who went on to bottle-feed. The method of feeding is the major influence on the hormonal status, and the experience of painful intercourse reported by breast-feeding mothers may be related to low oestrogen levels. Breast-feeding persistence is influenced by both social and psychological factors and its effect on sexual behaviour is discussed.

Breast Feeding↗
PubMed1986

Hormones, mood and sexuality in lactating women.

Of 25 primiparous women, investigated prospectively for six months post-partum, 19 persisted with breast feeding and six changed to artificial during the first six weeks. Sexual activity, mood, and feeding patterns were recorded in weekly diaries. Hormones were measured from weekly urine samples (oestrogen and pregnanediol) and fortnightly blood samples (prolactin, testosterone, androstenedione, and sex hormone binding globulin). In breast-feeding women, testosterone and androstenedione levels were significantly lower in those who reported severe reduction in sexual interest. Changes in sexuality or mood were not related to levels of prolactin or oestrogen, or to the return of follicular activity, which was delayed in persistent breast feeders. The relationships of mood, sexuality, and hormones are discussed.

Adult↗
PubMed1983

Breast feeding and post-natal depression.

Hormonal factors have been suggested as a cause of post-natal depression, but suckling frequency which is the major influence on hormone levels post-partum has not been considered in previous studies. Eighty-nine women who had taken part in a prospective study of post-natal depression were asked about their feeding patterns 18 months after childbirth. Half the mothers who were breast feeding introduced solids or artificial milk feeds before 12 weeks and were likely to have lowered prolactin levels and increased ovarian follicular activity. Mothers who totally breastfed their babies for at least 12 weeks or who were on the pill, had a higher incidence of post-natal depression than those who were not on the pill or who partially breastfed. Among the 62 women who attempted breast feeding those most likely to have normal levels of endogenous hormones were those least likely to have depressive symptoms.

Breast Feeding↗