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Biomedical subjects

J Hepworth

Publications and source records attributed to J Hepworth.

At least 19 recordsLinked to original sources
PubMed2004

Decision-making about hormone replacement therapy by women in England and Scotland.

OBJECTIVE: The aim of this study was to explore women's decision-making about the balance of risks and benefits of taking hormone replacement therapy (HRT) based on the latest evidence from the Women's Health Initiative (WHI) trial of combined HRT. METHODS: Women aged 50-69 years, who were eligible for the Women's International Study of long Duration Oestrogen after Menopause (WISDOM) trial, were invited to participate in one of eight focus groups. Participants were asked to discuss their views about taking HRT based on the latest international evidence. RESULTS AND CONCLUSIONS: Eighty-two women participated overall. Qualitative content analysis was applied to the discussion transcripts. Women regarded the decisions they make about taking HRT as highly personal, and, for women currently taking HRT, the overwhelming reason for continuation was perceived improvement in quality of life regardless of either the risks or the benefits in the longer term.

Aged↗
PubMed2003

Early skin-to-skin contact for mothers and their healthy newborn infants.

BACKGROUND: Early skin-to-skin contact involves placing the naked baby prone on the mother's bare chest at birth or soon afterwards (< 24 hour). This could represent a 'sensitive period' for priming mothers and infants to develop a synchronous, reciprocal, interaction pattern, provided they are together and in intimate contact. Routine separation shortly after hospital birth is a uniquely Western cultural phenomenon that may be associated with harmful effects including discouragement of successful breastfeeding. OBJECTIVES: To assess the effects of early skin-to-skin contact on breastfeeding, behavior, and physiology in mothers and their healthy newborn infants. SEARCH STRATEGY: The Cochrane Pregnancy and Childbirth Group and Neonatal Group trials registers (December 2002), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 4, 2002), MEDLINE (1976 to 2002). SELECTION CRITERIA: Randomized and quasi-randomized clinical trials comparing early skin-to-skin contact with usual hospital care. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality and extracted data. We contacted study authors for additional information. We collected adverse effects information from the trials. MAIN RESULTS: Seventeen studies, involving 806 participants, were included. We found statistically significant and positive effects of early skin-to-skin contact on breastfeeding at one to three months postbirth (odds ratio (OR) 2.15, 95% confidence interval (CI) 1.10 to 4.22), breastfeeding duration (weighted mean difference (WMD) 41.99, 95% CI 13.97 to 70.00), maintenance of infant temperature in the neutral thermal range (OR 12.18, 95% CI 2.04 to 72.91), infant blood glucose (WMD 11.07, 95% CI 3.97 to 18.17), infant crying (OR 21.89, 95% CI 5.19 to 92.30) and summary scores of maternal affectionate love/touch (SMD 0.73, 95% CI 0.36 to 1.11) during an observed breastfeeding within the first few days postbirth. We found no statistically significant benefit of early skin-to-skin contact for other major clinical variables: breastmilk maturation, maternal chest circumference, infant heart rate. REVIEWER'S CONCLUSIONS: Limitations included the methodological quality of the studies, variations in the implementation of the intervention and outcome variability. Early skin-to-skin contact appears to have some clinical benefit especially regarding breastfeeding outcomes and infant crying and has no apparent short or long-term negative effects. Further investigation is recommended. To facilitate meta-analysis of the data, future research in this area should involve outcome measures consistent with those used in the studies included here. Published reports should also clearly indicate if the intervention was skin-to-skin contact and include means, standard deviations and exact probability values.

Breast Feeding↗
PubMed1999

Support for patients with hepatitis C: an exploratory qualitative study of medical specialists' perceptions.

OBJECTIVE: To explore the range of meanings about the role of support for patients with hepatitis C by examining medical specialists' perceptions. METHOD: The study employed a qualitative, open-ended interview design and was conducted in four major teaching hospitals in Adelaide, South Australia. Eight participants (three infectious disease physicians, four gastroenterologists, one hepatologist), selected through purposive sampling, were interviewed about general patient support, their role in support provision, the role of non-medical support and their reasons for not using support services. RESULTS: Main themes included a focus on support as information provision and that patient education is best carried out by a medical specialist. The use of support services was defined as the patient's decision. Participants identified four key periods when patients would benefit from support; during diagnosis, failure to meet treatment criteria, during interferon treatment and following treatment failure. CONCLUSIONS: It was concluded that while barriers exist to the establishment of partnerships between specialists and other support services, this study has identified clear points at which future partnerships could be established. IMPLICATIONS: A partnership approach to developing support for patients with hepatitis C offers a systematic framework to facilitate the participation of health professionals and the community in an important area of public health.

Adaptation, Psychological↗
PubMed1999

Gender and the capacity of women with NIDDM to implement medical advice.

This qualitative study of women with non-insulin dependent diabetes mellitus (NIDDM) examined constructions of their diabetes management and socio-familial relationships as potential sources of support. Semi-structured interview data was collected from 16 women. The transcripts were analysed with the aim of examining the ways in which gender relations structured women's accounts of health-related behaviours. Women talked about themselves as wives, mothers, being pregnant and parenting, and friends of other women in ways that demonstrated how caring for others impeded their capacity to care for themselves. Meeting the food preferences of husbands and dietary requirements of diabetic husbands were dominant themes in women's accounts of marriage, and in various ways women justified their husbands' lack of support. Furthermore, the care of others during pregnancy and parenting was also an obstacle to women caring for themselves. An awareness of the gender politics inherent within social and family contexts is crucial to improving the effectiveness of medical advice for diabetes management.

Adult↗
PubMed1998

Accounts of experiences of bulimia: a discourse analytic study.

OBJECTIVES: To identify the variety of versions of bulimia constructed by participants, to suggest functions and consequences of these constructions, and to examine the sociocultural ideologies evident in participants' discourse. METHODS: Ten women and one man were interviewed about their experiences of bulimia. Transcribed interviews were analyzed using a discourse analytic approach. RESULTS: Five dominant ways of talking about bulimia were identified: Individuals were constructed as victims of bulimia, women were constructed as victims of social stereotypes, bulimia was constructed as a damaging action one performs on oneself, bulimia was constructed as a personality trait of individuals, and bulimia was marginalized as abnormal and disgusting. DISCUSSION: Sociocultural ideologies evident in participants' accounts included the valuing of individual will-power and self-mastery and the construction of a mind-body dichotomy entailing the need to control the latter. The analysis emphasizes the importance of considering the sociocultural context within which psychological problems occur.

Adult↗
PubMed1998

[Medical family therapy in children with chronic illness].

This article describes a medical family therapy approach to working with families of a child with a chronic medical illness. Medical family therapy combines the systemic paradigm of family therapy with the biopsychosocial paradigm of medicine to treat patients and families who are experiencing medical illness or disability. This article describes how family dynamics influence children's health and how children's health influences family dynamics. It then addresses special assessment issues, treatment issues, and collaboration issues for medical therapists when a child has a chronic illness.

Adaptation, Psychological↗
PubMed1995

The value of information supplied to clinicians by health libraries: devising an outcomes-based assessment of the contribution of libraries to clinical decision-making.

The Value project, a study funded by the British Library Research and Development Department and a group of postgraduate medical deans, has examined the effectiveness of NHS library and information services. Clinicians at 11 hospital library sites were asked to describe the purposes for which they needed information, the steps they took to obtain it, and to assess the value of the information obtained from interlibrary loan requests, database searches and end-user searches. A sample of non-library users and of users of the BMA Dial-Up MEDLINE service were also asked similar questions. Results show that information did, or would in the future, assist in personal clinical decision-making and which kinds of decisions were most supported. Information new to clinicians was often provided. Follow-up interviews provided illustrations of the ways in which developments aimed at more cost-effective patient care were supported by information obtained from the library. Results are being used to guide the production of a quality assurance toolkit to help libraries audit their services and improve the delivery of information to clinicians.

Clinical Medicine↗
PubMed1994

Qualitative analysis and eating disorders: discourse analytic research on anorexia nervosa.

The absence of qualitative analysis in mainstream research on eating disorders is discussed in the following article as being a weakness in developing theory and clinical practice. This article includes an analysis of interviews with British health-care workers who manage anorexic patients. This analysis presents an example of qualitative methodology in the form of discourse analysis, which is argued to provide a systematic, yet flexible approach to research on eating disorders. The overwhelming prevalence of anorexia nervosa in women is specifically examined within the context of the identification of the "discourse of femininity." The research findings are discussed in relation to the use of discursive practices that contribute to the maintenance and reproduction of clinical processes and their relative efficacy.

Adolescent↗
PubMed1994

Domiciliary air filtration units, symptoms and lung function in atopic asthmatics.

Air infiltration units (AFUs) incorporating a high efficiency particulate air filter are theoretically able to remove almost all potential airborne allergens. This may have implications for subjects with allergic lower respiratory disease. AFUs were placed in the living room of 12 atopic asthmatics, and the internal filters were inserted and removed in a double-blind fashion. No difference in subjective symptom scoring, spirometry or bronchial reactivity was demonstrated. Peak expiratory flow rate (PEFR) variability was significantly improved from baseline readings, and there was a trend towards higher mean PEFRs when the filters were present in the AFU. Trends towards lower levels of airborne micro-organisms were also demonstrated when the filters were present, however no effect upon total airborne dust and airborne Der pI could be demonstrated.

Air Conditioning↗
PubMed1993

Concentrations of the domestic house dust mite allergen Der p I after treatment with solidified benzyl benzoate (Acarosan) or liquid nitrogen.

BACKGROUND: Various methods of killing the house dust mite to reduce exposure to allergen are being promoted even though complete data on their effects on allergen concentrations are not available. A study was designed to measure the concentrations of the main house dust mite allergen Der pI in homes treated with either solidified benzyl benzoate (Acarosan) or liquid nitrogen. METHODS: Der pI concentrations were measured in dust collected from mattresses, bedroom carpets, and living room carpets in 10 houses treated with Acarosan and 10 houses treated with liquid nitrogen. Samples were collected before the treatment (in July 1990) and three and six months afterwards (October 1990 and January 1991). Forty untreated houses were concurrently sampled as controls. RESULTS: Der pI concentrations were similar in the three groups at baseline. No significant fall was seen in either of the two treated groups three or six months after treatment. Concentrations in the control houses increased significantly--twofold to threefold in dust sampled from mattresses and bedroom carpets between baseline and October 1990. This increase was not seen in either of the treated groups of houses, but there was no significant difference in the Derp pI concentrations in these houses and the control houses from any site at any time point. CONCLUSIONS: Neither Acarosan nor liquid nitrogen reduced the concentrations of Der pI for as long as six months after application. A small effect was probably present as the rise seen in control houses in the three month samples was not found in the treated houses. This effect, however, is likely to be of little clinical importance and also to be transient as the trend was lost by six months.

Allergens↗
PubMed1992

Absence of seasonal variation in concentrations of the house dust mite allergen Der p1 in south Manchester homes.

BACKGROUND: House dust mite numbers and the concentration of its main allergen, Der p1, depend on ambient temperature and humidity and have been reported to show a seasonal variation in homes in the United States. A study was designed to find out whether Der p1 concentrations vary with the seasons in dust collected from homes in north west England. METHODS: The concentration of Der p1 was measured in dust, collected every three months from April 1990 to April 1991, from mattresses and from bedroom and living room carpets in 40 houses in the south Manchester area. Twenty four hour recordings of indoor relative humidity were made in 20 houses during the sampling day. RESULTS: Mean concentrations of Der p1 from all three sources rose two to three fold in October. This was in contrast to the 1000 fold variation in concentrations of Der p1 present between houses within each season's sample and less than the 10 fold change considered to be of clinical importance. The autumn increase was paralleled by a rise in humidity. There was no statistical correlation, however, between Der p1 concentrations and relative humidity, house type, ventilation, or double glazing. CONCLUSIONS: The results suggest that seasonal variations in exposure to Der p1 exposure in north west England are small and unlikely to be of major clinical importance. The temperature and humidity data showed that the indoor environment remained relatively constant and conducive to mite growth throughout the year.

Allergens↗
PubMed1991

IT training. Through the training maze.

With information technology affecting every area of the health service, increasing numbers of staff are looking for training to help them keep up. John Hepworth offers some guidelines for choosing the right course.

Computer User Training↗
PubMed1990

Control of house dust mite antigen in bedding.

Bedding has been constructed with a vapour-permeable waterproof fabric that is impermeable to house dust mite antigen (Der p1). Der p1 levels per gram of mattress dust after 12 weeks' use of the new covering were 1% of levels in control samples from mattresses cleaned conventionally.

Adolescent↗