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Biomedical subjects

G Bickler

Publications and source records attributed to G Bickler.

13 recordsLinked to original sources
PubMed2000

Altogether now? Professional differences in the priorities of primary care groups.

BACKGROUND: Little is known about the similarities or differences with which Primary Care Group (PCG) Board members view the relative importance of the three functions with which they are charged, or how representative these views are of local primary care teams in general. This project explores the priorities of medical and nursing PCG Board members in relation to those of local General Practitioners (GPs) and practice nurses they represent. METHODS: Postal questionnaires were sent to GPs (n=236) and practice nurses (n= 137); structured telephone interviews were carried out with PCG Board members (n=61) in East Sussex, Brighton and Hove. RESULTS: There are large differences between the views of GPs and those of their nursing colleagues on how PCG Board members should determine priorities in their work. There are also marked differences in the priorities of PCG Boards (of whom the majority are GPs) and non-Board member GPs. Whereas around two-thirds of PCG Board members believe that improving health generally and reducing inequalities in particular are the most important tasks before them, this view is not shared by most GPs in the same localities, who are generally more concerned about commissioning services. There is some doubt among GPs generally about the suitability of PCG Board members as a vehicle for the tasks they have been set, and this doubt is also found among PCG Board members themselves. CONCLUSIONS: The priorities of PCG Board members of different disciplines need to be aligned in order that they have a clear focus on the tasks before them. PCG Boards must also have priorities that are consistent with the local practitioners who elected them. Effective systems of communication will need to be developed between PCG Board members, Health Authorities and individual Primary Care Groups. Local flexibility is essential to the success of Primary Care Groups, but tackling inequalities in health must always be at the forefront of their role.

Attitude of Health Personnel↗
PubMed1995

A corporate needs assessment for the purchase of district nursing: a qualitative approach.

A qualitative research methodology was applied to a corporate assessment of need for district nursing services. Semi-structured interviews were held with district nurses and the transcripts analysed for common themes. The major determinants of district nurses' roles were the priorities and practices of other community-based services, particularly social services and primary care. Purchasing and contract setting in this area needs to focus more on the interface with other services.

Attitude of Health Personnel↗
PubMed1995

Does routine screening for breast cancer raise anxiety? Results from a three wave prospective study in England.

OBJECTIVE: To investigate whether mammography raises anxiety in routinely screened women who receive a negative result. DESIGN: Prospective design in which women completed questionnaires at three key points in the breast screening process: at baseline (before being sent their invitation for breast screening), at the screening clinic immediately before or after screening, and at follow up, about nine months after baseline. Information was obtained from non-attenders as well as from attenders. SETTING: Bromley District Health Authority, served by the South East London Breast Screening Service. PARTICIPANTS: Two overlapping samples were used. Sample A comprised 1500 women aged 50-64 who were due to be called for first round screening at a mobile screening unit. Altogether 1021 (68%) returned a usable questionnaire and 795 of these (78%) also provided adequate information at nine month follow up: there were 695 attenders (including 24 women who received false positive results) and 100 non-attenders. Sample B consisted of 868 women who attended the screening unit in a three month period, 732 (84%) of whom provided adequate data. A total of 306 attenders (including 10 who received false positive results) occurred in both samples and provided adequate information on all occasions. The main analyses were based on these 306 women plus the 100 non-attenders. The analysis of retrospective anxiety took advantage of the larger sample size of 695 attenders. MAIN RESULTS: On average, the women were not unduly anxious at any of the three points in the screening process. Among attenders, there was no difference between anxiety levels immediately before and immediately after screening. Anxiety was lowest at the clinic and highest at baseline but the changes were very small in absolute terms. Anxiety did not predict attendance: there were no differences in anxiety levels between attenders and non-attenders at baseline. As expected, women who received false positive results recalled feeling extremely anxious after they had received the referral letter but their retrospective anxiety was also higher than in the negative screenees at earlier stages in the breast screening process. They also reported having experienced more pain and discomfort during the x ray. CONCLUSIONS: Anxiety does not seem to be an important problem in routinely screened women who receive a negative result. This finding is very reassuring in relation to a major criticism of breast screening programmes. Thus, apart from maintaining current procedures such as keeping waiting times to a minimum, there seems to be no need to introduce special anxiety reducing interventions into the national programme. On the other hand, the findings for women who received false positive results suggest that there are aspects of the experience of being recalled for assessment after an abnormal mammogram that warrant further attention. The relationship between contemporaneous and retrospective anxiety should also be studied.

Anxiety↗
PubMed1994

Variation in coverage by ethnic group of neonatal (Guthrie) screening programme in south London.

OBJECTIVES: To determine whether coverage of the neonatal (Guthrie) screening programme in Britain is different for groups at highest risk of sickle cell disease and to identify possible reasons for incomplete coverage. DESIGN: Descriptive study of coverage of screening programme and its variation by mobility, district of residence, and ethnic group. SUBJECTS: 1727 infants born between 1 October and 31 December 1991. SETTING: Former West Lambeth and Camberwell District Health Authorities, London. MAIN OUTCOME MEASURE: Proportion of infants with an identifiable screening test result. RESULTS: Screening covered 1663/1727 (96.3%) infants overall (745/786 (94.8%) in West Lambeth; 918/941 (97.6%) in Camberwell). The relative odds ratio of an African infant not having been tested compared with a white infant was 3.05 (95% confidence interval 1.30 to 7.14) (2.08 (0.86 to 5.01) after adjustment for mobility and district of residence). For infants whose families moved into the districts after the birth compared with those born and resident in the districts the relative odds ratio of having been tested was 10.16 (4.85 to 21.29). The odds ratio of locally delivered infants in West Lambeth not having been tested compared with those in Camberwell was 2.12 (1.08 to 4.16) after adjustment for ethnic group. CONCLUSION: Coverage of the screening programme is incomplete and poorer in infants of African ethnic group than in white infants. Poorer coverage is also associated with mobility of the family around the time of birth. The findings have implications for using the neonatal programme for testing for sickle cell disease and other disorders. Arrangements for monitoring the existing screening programme are inadequate and an improved system should be established, similar to the scheme that monitors the immunisation programme.

Africa↗
PubMed1994

Prospective study of predictors of attendance for breast screening in inner London.

OBJECTIVE: To investigate the predictors of first-round attendance for breast screening in an inner city area. DESIGN: Prospective design in which women were interviewed or completed a postal questionnaire before being sent their invitation for breast screening. Sociodemographic factors, health behaviours, and attitudes, beliefs, and intentions were used as predictors of subsequent attendance. A randomised control group was included to assess the effect of being interviewed on attendance. SETTING: Three neighbouring health districts in inner south east London. PARTICIPANTS: A total of 3291 women aged 50-64 years who were due to be called for breast screening for the first time. The analysis of predictors was based on a subsample of 1301, reflecting a response rate of 75% to interview and 36% to postal questionnaire. MAIN RESULTS: Attendance was 42% overall, and 70% in those who gave an interview or returned a questionnaire. There was little evidence for an interview effect on attendance. The main findings from the analysis of predictors are listed below. (These were necessarily based on those women who responded to interview/questionnaire and so may not be generalisable to the full sample.) (1) Sociodemographic factors: Women in rented accommodation were less likely to go for screening but other indicators of social class and education were not predictive of attendance. Age and other risk factors for breast cancer were unrelated to attendance, as was the distance between home and the screening centre. Married or single women were more likely to attend than divorced, separated, or widowed women, and black women had a higher than average attendance rate; however, neither of these relationships was found in the interview sample. (2) Health behaviours: Attenders were less likely to have had a recent breast screen, more likely to have had a cervical smear, more likely to go to the dentist for check ups, and differed from non-attenders with regard to drinking frequency. Exercise, smoking, diet change, and breast self-examination were unrelated to attendance. (3) Attitudes, beliefs, and intentions: The two best predictors were measures of the perceived importance of regular screening for cervical and breast cancer and intentions to go for breast screening. Also predictive were beliefs about the following: the personal consequences of going for breast screening, the effectiveness of breast screening, the chances of getting breast cancer, and the attitudes of significant others (the woman's husband/partner and children). Women who reported a moderate amount of worry about breast cancer were more likely to attend than those at the two extremes. CONCLUSIONS: Attenders and non-attenders differ in two broad areas: the health related behaviours they engage in and the attitudes, beliefs, and intentions they have towards breast cancer and breast screening. The latter are potentially amenable to change, and though different factors may operate among women who do not respond to questionnaires, the findings offer hope that attendance rates can be improved by targeting the relevant attitudes and beliefs. This could be done by changing the invitation letter and its accompanying literature, through national and local publicity campaigns, and by advice given by GPs, practice nurses, and other health professionals. It is essential that such interventions are properly evaluated, preferably in randomised controlled studies.

Attitude to Health↗
PubMed1992

The public health management of tuberculosis among the single homeless: is mass miniature x ray screening effective?

STUDY OBJECTIVE: The aim was to test the assumption that mass miniature x ray screening of the single homeless (hostel residents) is a cost-effective means of controlling pulmonary tuberculosis. DESIGN: The study was a prospective experimental screening exercise to identify new cases of active tuberculosis completing treatment. SETTING: The setting was eight hostels in south London. A mobile x ray screening facility was set up outside the hostels. SUBJECTS: Subjects were 547 single homeless residents in the hostels. They were encouraged to attend for chest x ray, and for active follow up of abnormal x rays. MAIN RESULTS: No new cases of active tuberculosis were found. CONCLUSIONS: Mass miniature x ray is ineffective in controlling tuberculosis because of its unacceptability and increasing inaccessibility to this population.

Adolescent↗
PubMed1989

Attendance and non-attendance for breast screening at the south east London breast screening service.

OBJECTIVES: To ascertain the reasons for a low rate of response for breast screening. DESIGN: All relevant aspects of the organisational process examined, including general practitioners' notes. Non-responders visited and interviewed. SETTING: An inner city breast screening service working on the model advocated by the Forrest report. SUBJECTS: 288 Women aged 50-64 registered with several general practices and invited for screening by post. MAIN OUTCOME: Determination of factors important for success of breast screening programmes. RESULTS: After five women were excluded by their general practitioners the response rate was 129 out of 283 (46%), but 99 (35%) of the women did not receive their invitations because of inaccuracies in the family practitioner committee's database and general practitioners failing to check women's addresses completely. CONCLUSIONS: Increased rates of response will depend on enabling general practitioners to check addresses and on an increased awareness of the importance of information.

Breast Neoplasms↗