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Biomedical subjects

H Bekker

Publications and source records attributed to H Bekker.

11 recordsLinked to original sources
PubMed1999

Breast screening: GPs' beliefs, attitudes and practices.

OBJECTIVES: We aimed to describe GPs' knowledge, beliefs and attitudes towards breast screening, and their association with practice-based organizations of breast screening. METHOD: A stratified randomized sample of 158 GPs from within the North-East and North-West Thames Health Regions were interviewed. RESULTS: Sixty-five per cent of GPs report checking the accuracy of invitation lists, and differ from those who do not, in having more knowledge about risk factors for breast cancer. Thirty-seven per cent of GPs report a policy of following up non-attendees for screening and differ from those who do not in three ways: a greater perception of the threat of breast cancer; a greater belief in the importance of GPs' role in increasing attendance of women for breast screening; and, a less-negative attitude towards breast screening. CONCLUSION: Women's attendance for breast screening may be increased by raising GPs' perceptions of the threat of breast cancer, addressing their concerns about breast screening and enhancing their views of the importance of the role of primary care in a national screening programme.

Breast Neoplasms↗
PubMed1996

Planning the development of cystic fibrosis gene carrier screening.

OBJECTIVES: It is now possible to test individuals to assess their cystic fibrosis gene carrier status and a range of strategies for screening the population have been piloted. The objective of this research was to develop a planning framework which health care planners and purchasers can use to assess the overall quantifiable outcomes and direct costs resulting from a year of alternative screening strategies and the ways costs and outcomes evolve over time. Beyond broader ethical and clinical considerations the information provided by such a framework is needed to support decisions surrounding the development of screening programmes. DESIGN: Operational Research modelling techniques were used to develop the planning framework. To help illustrate the framework it was then used to assess the quantifiable outcomes and direct costs of three of the main alternative screening strategies: from antenatal clinics, '2-step' screening where females are tested first followed by a screening invitation to the partners of female carriers, and 'couple' screening where both partners must agree to be tested at the outset; and from primary practice clinics 'active' contact of attenders. Quantifiable outcomes are defined as the number of individuals informed of their carrier status and the number of carriers, carrier couples, and affected fetuses detected. Direct costs are those associated with the recruitment and testing of individuals and the subsequent counselling of any gene carriers or carrier couples identified. Results are based on services for a resident population of 250,000 at two time points, year one and a year at 'steady state'. RESULTS: The resultant framework estimates the number of individuals tested using data on the size of the target population, the proportion of that population alerted to the screening service, and the proportion who agree to be tested when approached. Given service users, prevalence data are used to assess service outcomes. Given the number of individuals approached and the subsequent demands for services, service costs can be estimated. Preliminary results indicate that in the short-term health care purchasers and planners who favour screening are likely to opt for antenatal strategies. Although the high coverage of the primary practice strategy leads to high outcomes in year one, relative to the antenatal strategies, it also leads to very high costs. At 'steady state', cost and outcome differences between the strategies are less marked. CONCLUSION: This paper provides a framework which can be used to provide information to support decision-making surrounding the development of screening services. The methodology fills an important void in the literature and complements research elsewhere by health economists and by geneticists and their research colleagues. Preliminary findings based upon use of the approach demonstrate the need for continued research to further refine and improve the methodology.

Community Health Planning↗
PubMed1994

The impact of population based screening for carriers of cystic fibrosis.

The purpose of the study was to evaluate the short-term effects of population based screening for carriers of cystic fibrosis. The outcome measures included perceptions of health, anxiety, and understanding of test results. Those adults aged between 18 and 45, registered with a general practice in Inner London, who accepted the offer of carrier testing, completed questionnaires before testing, upon receipt of results, and three months later. Full data were obtained from 427 with negative test results and 14 carriers. Receipt of results had no effect upon perceptions of health or perceived risk of having an abnormal baby. Those receiving a positive test result were significantly more anxious upon receipt of this result. By three months, this anxiety had dissipated. While knowledge of the test improved from before to after testing, by three months there was some decay. Although the residual risk among those with a negative result of being a carrier was given as 1:135, at least 17% of those receiving a negative result incorrectly believed that they were at no risk of having a child with cystic fibrosis. Five of the 14 receiving a positive result erroneously believed that their results meant that they probably, but not definitely, carried the gene for cystic fibrosis. In the longer term the greatest problem of population screening would appear to be one of false reassurance rather than anxiety. Longer term studies are needed to determine how well carrier status information is retained, and how carriers and carrier couples plan and respond to pregnancy and how much understanding they retain of their test results.

Adolescent↗
PubMed1993

Uptake of cystic fibrosis testing in primary care: supply push or demand pull?

OBJECTIVE: To determine the acceptability and feasibility of screening for carriers of cystic fibrosis in a primary care setting. DESIGN: Follow up study over 15 months of patients offered carrier testing by mouthwash. SETTING: A general practice in inner London. SUBJECTS: 5529 patients aged 18-45 invited by various methods and combinations of methods (letter, booklet, personal approach) for testing. MAIN OUTCOME MEASURES: Uptake of screening, anxiety, and knowledge of test. RESULTS: 957 (17%) invitees were screened over the 15 months. 28 carriers and no carrier couples were detected. Uptake rates were 12% (59/502 patients) among patients invited by letter and tested by appointment; 9% (47/496) among patients invited by letter, with leaflet, and tested by appointment; 4% (128/2953) among patients invited by letter six weeks before the end of the study and tested by appointment; 17% (81/471) among patients offered passive opportunistic testing; 70% (453/649) among patients offered active opportunistic testing; and 25% (22/88) among patients offered active opportunistic testing by appointment. A short term rise in anxiety among those given a positive test result had dissipated by three months. At three months about one fifth and one third of those given positive and negative results respectively did not understand their results correctly. CONCLUSION: These results suggest that the strongest variable in determining uptake of screening is the active approach by a health professional offering immediate testing. It remains to be resolved whether the high uptake rates achieved by active recruitment indicate a supply push for this new test rather than a demand from the population.

Adolescent↗
PubMed1992

The development of a six-item short-form of the state scale of the Spielberger State-Trait Anxiety Inventory (STAI).

Two studies are reported describing the development of a short-form of the state scale of the Spielberger State-Trait Anxiety Inventory (STAI) for use in circumstances where the full-form is inappropriate. Using item-remainder correlations, the most highly correlated anxiety-present and anxiety-absent items were combined, and correlated with scores obtained using the full-form of the STAI. Correlation coefficients greater than .90 were obtained using four and six items from the STAI. Acceptable reliability and validity were obtained using six items. The use of this six-item short-form produced scores similar to those obtained using the full-form. This was so for several groups of subjects manifesting a range of anxiety levels. This short-form of the STAI is therefore sensitive to fluctuations in state anxiety. When compared with the full-form of the STAI, the six-item version offers a briefer and just as acceptable scale for subjects while maintaining results that are comparable to those obtained using the full-form of the STAI.

Adult↗