Biomedical subjects

J Astbury

Publications and source records attributed to J Astbury.

At least 19 recordsLinked to original sources

PubMed2006

Measuring the impact of intimate partner violence on the health of women in Victoria, Australia.

OBJECTIVE: Using burden of disease methodology, estimate the health risks of intimate partner violence (IPV) among women in Victoria, Australia. METHODS: We calculated population attributable fractions (from survey data on the prevalence of IPV and the relative risks of associated health problems in Australia) and determined health outcomes by applying them to disability-adjusted life year estimates for the relevant disease and injury categories for Victoria, Australia for 2001. FINDINGS: For women of all ages IPV accounted for 2.9% (95% uncertainty interval 2.4-3.4%) of the total disease and injury burden. Among women 18-44 years of age, IPV was associated with 7.9% (95% uncertainty interval 6.4-9.5%) of the overall disease burden and was a larger risk to health than risk factors traditionally included in burden of disease studies, such as raised blood pressure, tobacco use and increased body weight. Poor mental health contributed 73% and substance abuse 22% to the disease burden attributed to IPV. CONCLUSION: Our findings suggest that IPV constitutes a significant risk to women's health. Mental health policy-makers and health workers treating common mental health problems need to be aware that IPV is an important risk factor. Future research should concentrate on evaluating effective interventions to prevent women being exposed to violence, and identifying the most appropriate mental health care for victims to reduce short- and long-term disability.

Adolescent↗

PubMed2001

'Oh it's a wonderful practice... you can talk to them': a qualitative study of patients' and health professionals' views on the management of type 2 diabetes.

This paper uses 85 semistructured interviews with people with type 2 diabetes, and with the health professionals who deliver their diabetes care, to explore the issues that they perceive as central to effective management of diabetes, primarily within a primary care setting. Attention is especially focused on the nature of the patient-practitioner relationship, and on the implications of this for patient empowerment and the effective self-management of diabetes. The paper is organized around five key concepts identified in the qualitative analysis: the importance of having sufficient time for consultations, the significance of continuity of care through a named individual, the need for patients to have an opportunity to ask questions during a consultation, the extent to which patients feel that they are listened to by health professionals, and the variability of each patient's individual experience of living with diabetes. In conclusion, these themes are briefly related to key issues in the geography of health.

Aged↗

PubMed2001

Women's experience of IVF: a follow-up study.

The aim of this research was to increase understanding of how women feel about the experience of IVF 2-3 years after ceasing treatment. A questionnaire covering issues relating to infertility and the value of the experience of IVF together with three self-report measures [Satisfaction With Life Scale (SWLS), Golombok Rust Inventory of Marital State (GRIMS) and General Health Questionnaire (GHQ-12)] were mailed to all women (n = 229) who had their last contact with the clinic in 1994. The response rate was 55%. Having a baby positively influenced the recall of the IVF experience. Women who did not have a baby were more critical about the clinic and more negative about the experience of treatment but did not regret having tried IVF. These women had statistically significantly lower scores on SWLS but did not differ from those with babies on GRIMS and GHQ-12 scales. The results give insight into how women look back on the IVF experience and what aspects of treatment they recall as particularly difficult. The findings can be used by providers of IVF to implement strategies that may reduce stress and improve the patients' well-being.

Adult↗

PubMed2000

The impact of domestic violence on individuals.

There is extensive evidence of the adverse effects of domestic violence across all age groups and cultural backgrounds. The impact of domestic violence may be long-term, affecting emotional adjustment, physical health and subsequent relationships. Health professionals should be aware of the confounding effect of youth, age and cultural diversity on presentation. Shame and isolation militate against disclosure. Specific, sensitive questioning that incorporates awareness of cultural and social issues is essential to detect domestic violence and initiate appropriate assistance.

Aged↗

PubMed2000

Body image and psychological well-being in pregnancy. A comparison of exercisers and non-exercisers.

This study compared the perceptions of body image and psychological well-being between exercising and non-exercising pregnant women. A prospective longitudinal study was conducted with 65 nulliparous women (mean age years = 30.3, range = 23-39) who were allocated to 2 groups based on level of recreational exercise participation; 25 exercisers were compared with 18 non-exercisers. A self-report exercise history questionnaire and a 10 item Body Cathexis Scale were completed on two occasions during the pregnancy, at approximately 17 weeks and 30 weeks of gestation. The General Health Questionnaire (GHQ-28) was administered in late pregnancy. There was a significant difference between the exercise group and the non-exercise group in late pregnancy for some items on the Body Cathexis Scale. The exercise group had a lower level of probable caseness on the GHQ-28 with reduced frequency of somatic symptoms, anxiety and insomnia, and a higher level of psychological well-being.

Adult↗

PubMed1999

Evaluation of a scheme for the pre-distribution of stable iodine (potassium iodate) to the civilian population residing within the immediate countermeasures zone of a nuclear submarine construction facility.

BACKGROUND: The Barrow-in-Furness stable iodine (potassium iodate) tablet pre-distribution scheme was the first of its kind to be introduced to protect the population living around a fixed site nuclear facility in the United Kingdom. Pre-distribution schemes have attracted critical comment principally because the certainty of availability of potassium iodate tablets was unknown. This study aimed to establish the reliability of such a scheme. METHOD: A structured interviewer-administered survey of a random sample of households served by the pre-distribution scheme was carried out using a standardized questionnaire. RESULTS: The ability of this scheme to provide stable iodine protection declined from 100 per cent to 60 per cent coverage over a period of two years for the designed worst-case demand (the ability to supply stable iodine tablets to all household residents normally living within the pre-distribution scheme zone). CONCLUSIONS: Pre-distribution has value in areas where evacuation to a centre where stable iodine tablets are available or post-accident distribution to sheltering households is difficult. The value of such a scheme must be calculated against a predictable decline in its effectiveness. In implementing such a scheme it should be noted that this decline in coverage can be reduced by calculating the frequency with which tablet packs are redistributed to take account of this factor.

Disaster Planning↗

PubMed1999

A randomized controlled trial of a smoking cessation intervention during pregnancy.

This study was a randomized controlled trial of a smoking cessation intervention for pregnant smokers. Women who reported smoking at their first antenatal visit and satisfied the inclusion criteria were asked to participate in the trial. Analysis was restricted to 393 evaluable women in the control group (received usual antenatal care) and 339 women to the study group (received usual antenatal care plus the intervention). The primary hypotheses were that the intervention would result in a higher proportion of quitters and that the mean birth-weight of babies born to women receiving the intervention would be greater than that of babies born to women in the control group. The outcome measures were smoking status based on self-report combined with a urinary cotinine level of <115 ng/mL, and birth-weight. There was no significant difference in quit rate between women receiving the intervention and women in the control group (11.9% versus 9.8% p=0.41). Babies born to women receiving the intervention were on average 84 g heavier than babies born to controls (p=0.04). The factors that contribute to the lack of a significant increase in smoking cessation in the intervention group and the possible explanation for the changes in birth-weight are discussed.

Adult↗

PubMed1998

"A survey of antenatal clinic staff: some perceived barriers to the promotion of smoking cessation in pregnancy".

Antenatal clinic staff were surveyed for their attitudes to smoking in pregnancy in 1993 and again in 1996 to monitor the effect of a randomised controlled trial of a smoking intervention conducted in the clinic over the period. Descriptive analysis showed that staff believe smoking in pregnancy is an important health risk for both mother and baby, quitting smoking is difficult, counselling is only moderately successful, they lack the skill to counsel smokers and there is little time to do so. The lack of structural support within clinic administration, the lack of a comprehensive hospital policy on smoking and unclear public health messages, were also identified as barriers to reducing the prevalence of smoking.

Adult↗

PubMed1998

Informal care and psychiatric morbidity.

BACKGROUND: We aimed to examine and quantify the relationship between psychiatric morbidity and the provision of informal care in the community. METHODS: The study involved a comparison of carers and non-carers in a mixed urban and rural community (Morecambe Bay Health Authority). Data were collected by postal survey for 4550 adults; 10.9 per cent of respondents were identified as carers. Subjects were selected by quasi-random methods from the Family Health Services Authority (FHSA) registers. Potential psychiatric morbidity was defined as three or more symptoms on a standardized measure, the General Health Questionnaire (12-item version). RESULTS: The prevalence of morbidity was significantly higher in people who care for others in their own homes, even after adjustment for other known risk factors for psychiatric morbidity (odds ratio 1.51, 95 per cent confidence interval 1.11-2.05). In contrast, there was no significant relationship between morbidity and care outside the home in these data. CONCLUSION: Health Authorities need to review support for carers and to consider ways to improve monitoring.

Adult↗

PubMed1997

Women who spontaneously quit smoking in early pregnancy.

Spontaneous quitters are prepregnancy smokers who quit by the time of their first antenatal visit. We recruited 192 self-declared spontaneous quitters and 407 smokers at their first visit to the antenatal clinic at the Royal Women's Hospital during April, 1994-May, 1995. Spontaneous quitters made up 23% of prepregnancy smokers. Information about self-declared quitters and smokers was collected by self-completed questionnaires. Urine samples collected at the first visit and in late pregnancy were assayed for cotinine to validate smoking status. A cut-off urinary concentration of > or = 653 nmol/L cotinine was used to determine active smoking. At the first visit, 20% of the self-declared spontaneous quitters were smoking and by late pregnancy, regardless of their initial biochemically verified status, 27% were smoking. Spontaneous quitters were different from women who said they were still smoking at their first antenatal visit, in a range of demographic variables and measures of addictive behaviour.

Adult↗

PubMed1997

Adverse psychological impact of operative obstetric interventions: a prospective longitudinal study.

OBJECTIVE: This paper reports the findings of a prospective longitudinal study of 272 nulliparous pregnant women, which investigated as one of its objectives the psychological sequelae of obstetric procedures. METHOD: Participants completed structured interviews and standardised, published psychometric questionnaires, including the Rosenberg Self-Esteem Scale and the Profile of Mood States late in pregnancy and again early in the postpartum period. RESULTS: Little evidence was found to support the notion that the total number of obstetric interventions was linked to a deterioration in postpartum mood. Significant adverse psychological effects were associated with the mode of delivery. Those women who had spontaneous vaginal deliveries were most likely to experience a marked improvement in mood and an elevation in self-esteem across the late pregnancy to early postpartum interval. In contrast, women who had Caesarean deliveries were significantly more likely to experience a deterioration in mood and a diminution in self-esteem. The group who experienced instrumental intervention in vaginal deliveries fell midway between the other two groups, reporting neither an improvement nor a deterioration in mood and self-esteem. CONCLUSIONS: The findings of this study suggest that operative intervention in first childbirth carries significant psychological risks rendering those who experience these procedures vulnerable to a grief reaction or to posttraumatic distress and depression.

Adult↗

PubMed1996

The abortion decision: fantasy processes.

This paper considers that features intrinsic to pregnancy and to an unwanted pregnancy/abortion decision heighten the likelihood of the occurrence, and the importance, of fantasy in the decision-maker's thinking. In addition, investigation of fantasy or non-rational processes in an abortion decision emphasizes the complexity of decision-making in a way which may challenge ideas of decision-making in general. The results of a pilot study using a short fantasy inventory with 20 women facing an abortion decision are presented to highlight fantasy, not as irrational or pathological, but as legitimately coexisting with logical, reasoning, non-fantasy thought in the abortion decision. The clinical value of the fantasy inventory is explored.

Abortion, Induced↗

PubMed1995

The abortion decision: reasons and ambivalence.

Self-in-relation theory and pilot data responses to an Abortion Decision Balance Sheet by 20 women attending an abortion-providing clinic challenge previous formulations of the abortion decision. Pilot data suggest that: women may make an abortion decision based primarily on pragmatics, a belief in their right to choose and knowledge of the safety and simplicity of the procedure. A discrepancy may exist for a significant minority of women between their abstract beliefs/knowledge and the personal meaning for them of the pregnancy, abortion and its safety. Important links may exist between maternal attachment and anxiety about the safety of the abortion procedure. Ramifications for counselling and future research are discussed.

Abortion Applicants↗

PubMed1995

Private health insurance and a healthy personality: new risk factors for obstetric intervention?

In this study 242 nulliparous pregnant women completed standardized psychometric questionnaires and semi-structured interviews in the latter half of pregnancy and again 4-6 weeks postpartum. Discriminant function analysis revealed that the use of operative obstetric interventions was measurably influenced by psychosocial factors. Privately insured women were significantly more likely to experience instrumentally assisted (relative risk = 1.53, 95% CI: 1.05, 2.25) and Caesarean (relative risk = 1.91, 95% CI: 1.05, 3.46) deliveries than those receiving care in the public hospital system. The likelihood of experiencing these procedures was increased further among those who in late pregnancy were thinking clearly, had high self-esteem, mature means of dealing with anxiety, were confident in their knowledge of childbirth procedures and in secure partnerships with highly educated men. There was no evidence that either elevated anxiety or abnormalities of personality contributed to obstetric outcome. These findings indicate that obstetric decision-making is significantly influenced by patient personality and socioeconomic circumstances. In particular, they suggest that fear of malpractice litigation, physician convenience factors and the response of obstetricians to assured, well pregnancy-educated pregnant women may be influencing the use of operative intervention in delivery.

Adult↗

PubMed1994

Depression after childbirth. Does social context matter?

OBJECTIVE: To explore the relationships between women's emotional well-being after childbirth and several measures of the social context of motherhood. DESIGN AND PARTICIPANTS: Case-control study of 45 women who were identified as depressed in a population-based postal survey 8-9 months after giving birth and 45 randomly selected women who were not depressed. At follow-up about two years after the birth, the women were interviewed at home about their experiences of motherhood and their emotional well-being since the birth. They also completed five standard questionnaires: Life Experiences Questionnaire; Toddler Temperament Scale; Social Support Questionnaire; Experience of Motherhood Questionnaire; and the Edinburgh Postnatal Depression Scale. RESULTS: Women in the case group were more likely to be depressed at follow-up than women in the control group. They reported less practical and emotional support from their partners and saw themselves as having less social support overall. They had also experienced more negative life events since the birth, had poorer health and were somewhat more likely to have a "difficult" toddler. CONCLUSIONS: It is important to take social context into account in understanding depression after childbirth and in helping mothers who are depressed.

Case-Control Studies↗

PubMed1994

Birth events, birth experiences and social differences in postnatal depression.

A postal survey of all women who gave birth in Victoria in one week in 1989 was used to assess the contribution of birth events, satisfaction with care and social differences to depression after birth. The questionnaire was mailed to women eight to nine months after birth. The survey response was 71.4 per cent (790/1107) with underrepresentation of young women, single women and women of non-English-speaking background. Assessment of depression was made using the Edinburgh Postnatal Depression Scale, with a score of 13 or more indicating probable clinical depression. The point prevalence of depression was 15.4 per cent (95 per cent confidence interval 12.8 to 18.0). In the final logistic model two factors were associated with lower odds of depression: nonmetropolitan residence and maternal age over 34. Factors associated with increased odds of depression in the model were having a first child over the age of 34, assisted delivery (caesarean, forceps, vacuum extraction), bottle feeding, dissatisfaction with antenatal care, having unwanted people present at the birth and lacking confidence to look after the baby at the time of leaving hospital. When those factors were taken into account, being unmarried, being born overseas of non-English-speaking background, being dissatisfied with care in labour and after birth, and not having an active say in decision making, all of which were significantly associated with depression in univariate analyses, did not make any additional contribution to the model.

Adolescent↗

PubMed1993

Shigellosis due to occupational contact with non-human primates.

A small cluster of dysenteric illness, due to Shigella flexneri, was identified among technical assistants of a primate research unit. All of the affected individuals had been in regular contact with a colony of cynomolgus macaque monkeys, one of which was known to have suffered from acute haemorrhagic colitis in the preceding few weeks. Four monkeys were found to be excreting S. flexneri bacilli of identical antigen type (1b) to that isolated from the human cases. Investigation of working practices revealed the potential for inadvertent faeco-oral spread and the need to improve existing control methods. We conclude that this small outbreak of shigellosis represents a primate-associated occupational zoonosis. The risk may not be fully appreciated by handlers or their doctors.

Animals↗

PubMed1990

Neurodevelopmental outcome, growth and health of extremely low-birthweight survivors: how soon can we tell?

A three-year cohort of extremely low-birthweight (ELBW, less than 1000g) survivors born between 1st January 1979 and 31st December 1981 were followed prospectively at one, two and five years of age, corrected for preterm birth. 57 of 110 infants survived, and 53 children were still alive at five years. The diagnoses of cerebral palsy, blindness, deafness and developmental delay fluctuated markedly according to age at developmental assessment. Although 13 of the 53 children were found to have impairments at five years, only seven were identified at one year, while 17 were identified at two years. In relation to the five-year assessment, impairments were underestimated at one year and developmental delay was overestimated at two years, which suggest that valid and reliable estimation of adverse neurodevelopmental sequelae among ELBW survivors may not be possible until school-age.

Blindness↗