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Biomedical subjects

J A Dunbar

Publications and source records attributed to J A Dunbar.

At least 19 recordsLinked to original sources
PubMed2004

Food cost and availability in a rural setting in Australia.

INTRODUCTION: The burden of chronic diseases is rapidly increasing worldwide. In Australia rural populations have a greater burden of disease. Chronic diseases are largely preventable with diet as a key risk factor. With respect to diet-related chronic disease, dietary risk may be due to poor food access, namely, poor availability and/or the high cost of healthy food. It is likely that poor food access is an issue in rural areas. OBJECTIVE: To assess food access in rural south-west (SW) Victoria, Australia. METHODS: A total of 53 supermarkets and grocery stores in 42 towns participated in a survey of food cost and availability in the rural area of SW Victoria. The survey assessed availability and cost of a Healthy Food Access Basket (HFAB) which was designed to meet the nutritional needs of a family of 6 for 2 weeks. RESULTS: Seventy-two percent of the eligible shops in SW Victoria were surveyed. The study found that the complete HFAB was significantly more likely to be available in a town with a chain-owned store (p <0.00). The complete HFAB was less likely to be available from an independently owned store in a town with only one grocery shop (p <0.004). The average cost of the HFAB across SW Victoria was AU380.30 dollars +/- 25.10 dollars (mean +/- SD). There was a mean range in difference of cost of the HFAB of 36.92 dollars. In particular, high variability was found in the cost of fruits and vegetables. CONCLUSIONS: Cost and availability of healthy food may be compromised in rural areas. IMPLICATIONS: Improvements in food access in rural areas could reduce the high burden of disease suffered by rural communities.

Journal Article↗
PubMed2004

A virtual clinic: telemetric assessment and monitoring for rural and remote areas.

This article reports the establishment of a pilot 'virtual clinic' in a rural region of Victoria, Australia. Using low-cost videophones that work across ordinary phone lines, together with off-the-shelf (mostly automatic) clinical tools, local volunteers have been trained to mediate a virtual consultation between simulated patients and local GPs. This system has the potential to save long trips into town by such patients since the traditional 'home visit' is not feasible, as well as to provide regular home monitoring for those with chronic conditions. This in turn should impact favourably on ambulance deployment, sometimes enabling patients to avoid going to hospital or allowing them to come home sooner than otherwise would be the case, and generally to offer a sense of medical security to those living in isolated regions.

Journal Article↗
PubMed1998

Vertical strabismus resulting from an anomalous extraocular muscle.

Unusual ocular motility abnormalities have been rarely reported to result from anomalous extraocular structures. These structures, which may be either muscular or fibrotic, attach to the globe and produce a mechanical restriction resulting in incomitant strabismus. To our knowledge, we report the first patient with an anomalous extraocular muscle in whom the clinical, radiologic, surgical, and histopathologic findings are described.

Child, Preschool↗
PubMed1998

Implementing the North Karelia Project in Scotland.

A comprehensive, determined and theory-based community programme can have a meaningful and positive effect on risk factors and life styles. In much the same way as the North Karelia Project was rolled out to cover the whole of Finland, there is no reason why our intervention schemes could not be rolled out to cover the whole of Scotland. The North Karelia Project proved that a major national demonstration programme can be a strong tool for favourable national development in chronic disease prevention and health promotion.

Adult↗
PubMed1997

Integrating clinical pharmacists into the primary health care team: a framework for rational and cost-effective prescribing.

A recent Audit Commission report into general practice prescribing identifies areas where general practitioner and pharmacist collaboration could be beneficial. Two such areas are formulary development and repeat prescribing review. Increased generic prescribing is encouraged in the report and in central priorities for Scottish Health Boards. This study was designed to develop and assess the effects on prescribing, of a practice formulary and a procedure for change to generic name prescribing. A practice formulary, standards for generic name prescribing and an approach to prescribing review were agreed, developed and implemented. Formulary compliance and the extent of prescribing generically and of changes to generic prescriptions were assessed by prospective prescription monitoring. Consultations resulting in a prescription reduced from 69% to 59% and 80% of acute prescribing events were met from 144 formulary medicines. Rapid change to generic name prescriptions was achieved without patient complaints and the overall generic prescribing level increased from 57% to 68%. Eighty percent of all new prescriptions were generic.

Cost-Benefit Analysis↗
PubMed1996

Rapid prescribing change, how do patients respond?

The cost of prescribed medication is an increasing burden on health care systems. British general practitioners have been encouraged to reduce their prescribing costs through financial incentives within the fundholding scheme. This study reports on one general practice which reduced prescribing expenditure as part of the move to fundholding. Interviews performed with practice staff and patients were analysed and combined with prescribing statistics and questionnaire data to give a picture of the balance between the experience of patients and practitioners. Fifty-three interviews with 17 patients revealed that most were willing to try cheaper treatments and that dissatisfaction was primarily with the communication they received rather than the change itself. Each patient had to decide how to respond to the change in their medication. The decision-making process and the main factors involved are described and discussed. The experience of having long-standing treatment changed can have an impact on the doctor-patient relationship. This was not found to be a large problem and, it is suggested, can be guarded against. Large-scale economies in prescribing are feasible for some practices, and patients will tolerate such changes if attention is paid to sensitive communication.

Communication↗
PubMed1995

Changing to generic formulary: how one fundholding practice reduced prescribing costs.

OBJECTIVES: To observe one general practice's attempt to reduce prescribing costs on becoming third wave fundholders through the introduction of a generic formulary applied to all new and repeat prescribing. To assess the impact on patients and prescribing patterns. DESIGN: An observational study using interviews with patients and practitioners; questionnaires for patients and prescribing data. SETTING: One urban general practice with five partners in Scotland. It became fundholding in April 1993. SUBJECTS: 71 searches of the register of repeat prescriptions identified 1274 potential changes in drugs. Questionnaires were sent to a stratified random sample of 280 patients four months after the changes were made; 33 interviews were conducted with 17 patients selected by local pharmacists to represent a wide range of opinion. MAIN OUTCOME MEASURES: Changes in prescribing and response and satisfaction of patients. RESULTS: Of intended changes, 129 (70%) were in place after four months. Thirty three (20%) of the 167 patients who returned questionnaires were "very unhappy," though interviews suggested that this was primarily with the communication they received rather than the change itself. Generic prescribing rose from one in three (37%) to over a half (58%). The volume of treatment dispensed (as treatment days) fell by 67,674 (10.7%), and the average cost per day's treatment fell by 3.1 p from 32.3 p per day in 1992 (9.4%), producing a total absolute saving of 24% (137,712 pounds) over the first year. CONCLUSION: This practice has achieved a large reduction in prescribing costs rapidly. These were tolerated by patients, none of whom is thought to have left the practice for this reason. Great care must be taken to inform patients appropriately.

Communication↗
PubMed1991

Deaths from road traffic accidents in Scotland: 1979-1988. Does it matter where you live?

The purpose of this study was to calculate and compare the geographical distributions of male and female deaths from road traffic accidents in Scotland. A retrospective, nationwide study of deaths from road traffic accidents was undertaken; all road traffic deaths between 1979 and 1988 were included. Deaths were abstracted from the Annual Reports of the Registrar General for Scotland. Standardized mortality ratios (SMRs) for males and for females were calculated for 1979-83 and 1984-88. Maps showing the distributions of high SMRs (SMR greater than 135 or P less than 0.05) and low SMRs (SMR less than 65 or P less than 0.05) were prepared for males and females separately. The geographical distributions of deaths from road traffic accidents in Scotland were dissimilar to those of England and Wales. For both sexes, high mortality was predominantly in the sparsely populated regions of the north and south of Scotland; whereas low mortality was found in the cities and the populous central belt. Possible reasons for this pattern are discussed: speed, response time (both of notification of the accident and of arrival of the ambulance), distance to nearest hospital with suitable emergency facilities, and road conditions.

Accidents, Traffic↗
PubMed1990

Alcohol consumption, blood alcohol level and the relevance of body weight in experimental design and analysis.

In healthy male subjects, intake of alcohol is not closely related to body weight although there is a significant correlation between consumption and body weight in the younger age group. No association was observed between age and alcohol consumption. Age did show a significant association when expressed in terms of intake per weight. Eight hours after consumption blood alcohol did not vary significantly in people with different body weight; total body water is probably the key factor. This study raises doubts about experimental designs and calculations of blood alcohol whereby assumption is made that correcting alcohol dose for body weight would give precise information. Conclusions from such studies could in fact be misleading.

Adolescent↗
PubMed1988

Contribution of alcohol to deaths in road traffic accidents in Tayside 1982-6.

In Britain the precise number and relative proportions of deaths among drivers, passengers, and pedestrians in road traffic accidents related to alcohol are not known. These data were obtained in Tayside by cross matching police accident records with blood alcohol concentrations at necropsy. Of 71 alcohol-related deaths 30 were the drivers (or motorcyclists) themselves, nine were their passengers, 23 were pedestrians with raised blood alcohol concentrations, and nine were innocent victims. The high blood alcohol concentrations of the intoxicated drivers, passengers, and pedestrians, which may point to alcoholism, suggest that publicity campaigns will be of little value in reducing the number of deaths in road traffic accidents related to alcohol. The time at which these accidents occurred was related to licensing hours and this should be taken into account when considering changes in licensing laws.

Accidents, Traffic↗
PubMed1987

Drinking and driving: choosing the legal limits.

The legal limit for drinking and driving in Britain is 80 mg/dl (17.4 mmol/l) of alcohol in the blood. This was chosen 20 years ago on the basis of studies that have recently been reanalysed. Changes in public opinion, the results of recent research, and the evaluation of other countermeasures, such as random breath testing, show that there are good grounds for revising the legal limit downwards. It is suggested that the legal limit should be reduced from 80 mg/dl to 50 mg/dl (10.9 mmol/l) and random breath testing introduced as in most Nordic countries. A zero limit is proposed for learner and first year drivers, who are likely to have accidents even with low concentrations of alcohol in their blood.

Accidents, Traffic↗
PubMed1987

Drinking and driving: success of random breath testing in Finland.

Since the introduction of random breath testing in Finland in 1977 the drinking and driving rate has halved, and there has been an appreciable reduction in the rates of death and injury from road accidents associated with drinking. The results of Finnish studies indicate that random breath testing deters social drinkers and detects problem drinkers. Problem drinkers are more likely to be driving in morning traffic, when vulnerable road users such as children are about, and are more likely to be detected by random breath testing than by any other police activity. Random breath testing is a popular measure and has not only saved lives but has paid for itself by savings in health service and other resources. Introducing random breath testing into Britain could save at least 400 lives a year. The main recommendation of the Blennerhassett report of 1976--discretionary testing--is compared with the success of random breath testing in Finland.

Accidents, Traffic↗