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Biomedical subjects

J Hilditch

Publications and source records attributed to J Hilditch.

7 recordsLinked to original sources
PubMed1998

'Home hypertension': exploring the inverse white coat response.

BACKGROUND: The classical 'white coat response' to blood pressure measurement has been studied thoroughly. However, little is known about patients showing a reverse pattern, i.e. who have lower blood pressure readings at the clinic than outside healthcare facilities. AIM: To estimate the proportion of patients whose blood pressure levels as determined by self-measurements at home are higher than those taken at the clinic and to explore possible associations with demographic, clinical, and psychological variables. METHOD: Patients consecutively attending (n = 214) an academic family medicine department in Toronto, Canada, were eligible. Subjects aged below 16 years and those on psychotropic or blood pressure-lowering agents were excluded. The clinic-home blood pressure difference (CHBPD) was calculated for each participating subject by subtracting home blood pressure from clinic blood pressure. Those who had negative values were compared with the rest of the sample. RESULTS: A considerable proportion of patients had lower blood pressure at the clinic than at home (systolic, 34.6%; diastolic, 23.8%). These subjects did not differ from the rest of the sample with regard to age, sex, levels of education attained, immigration status, body mass index, experience of current symptoms, blood pressure levels, or psychological distress. However, in patients with a 'negative CHBPD', i.e. lower blood pressure at the clinic than at home, readings taken by an automatic, self-inflating device when still at the clinic were higher than in the rest of the sample. CONCLUSION: The results point to measurement bias being at least partly responsible for higher blood pressure readings outside the clinic. Automatic measurement devices used for self/home blood pressure measurement seem to cause an alerting reaction analogous to the well-described 'white coat response'.

Ambulatory Care↗
PubMed1995

Do widowers use the health care system differently? Does intervention make a difference?

OBJECTIVE: To describe the health care use patterns of widowers who had participated in a randomized trial of mutual support, and of a matched cohort of married men DESIGN: Retrospective audit of Ministry of Health use data SETTING: The family practice unit in a general teaching hospital. PARTICIPANTS: The 113 new widowers (61 treatment, 52 waiting-list controls) who participated in a randomized trial of mutual support, and 111 married men matched for age INTERVENTIONS: Mutual support program MAIN OUTCOME MEASURES: Monthly rates of visits to family physicians, psychiatrists, and all other specialists for the three cohorts RESULTS: Visit rates to family physicians and specialists (SPs) for the married men were stable for the 20 months of the study; rates for the widowers rose significantly from the time of loss to the end of the intervention (for FPs, f = 13.18, df = 2, P < .01; for SPs, f = 5.34, df = 2, P = .005). Rates for FPs declined after intervention for the treatment group, but kept rising among the controls (f = 4.17, df = 1, P = .044). CONCLUSIONS: The decreased physician visit rate among those taking part in the mutual support program suggests that this program met some of the widowers' social support needs that would otherwise have led to the use of health care resources.

Aged↗
PubMed1988

Small hospital obstetrics: is small beautiful?

The number of deliveries in small Canadian hospitals over the last 15 years was reviewed. The two provinces with the highest percentage of deliveries in small hospitals had similar patterns of Perinatal Mortality Rates to the two provinces with the lowest percentage of small hospital deliveries. Birthweight specific mortality rates for newborns weighing greater than 2,500 grams was lower in small hospitals compared to larger hospitals in the provinces of Ontario, Newfoundland and Saskatchewan for 1985. In Ontario, for the year 1985, even when corrected for perinatal transfers and the home address of the mother, there were no significant differences in perinatal mortality between those hospitals with less than 400 births, those between 401 and 2,999 births and those with 3,000 or more births. Within the present Canadian system of perinatal regionalization, small hospital obstetrics is safe.

Delivery, Obstetric↗
PubMed1984

Diagnosis and management of hypertension: the stated practices of family physicians.

Hypertension is an important and common problem in family practice, but there is no general agreement on the systolic and diastolic pressures at which it should be diagnosed and treated. Responses from 273 family physicians surveyed by mail in Metropolitan Toronto showed a wide variation in the pressures used as cut-off points. The probability that in a given patient hypertension would be diagnosed or treated at different systolic and diastolic pressures varied considerably among the physicians, the variation increasing with the age of the patient. There was also wide variation in opinion among the surveyed physicians about how often patients should be screened for hypertension; depending on the patient's age, up to 35% of the physicians stated that the blood pressure should be measured at every visit. Only one third reported using any one or more methods to ensure that patients with hypertension were not lost to follow-up. The family physicians with an academic appointment used higher cut-off points for diagnosis and treatment, and they screened and scheduled follow-up visits less frequently than those without an academic appointment.

Adult↗
PubMedDate not supplied

A comparison of psychosocial characteristics of new widowers and married men.

Bereavement is a stressful event for men, yet there are few studies that help explain the important psychological and social factors that may interfere with or facilitate the grieving process in men. The purpose of this study is to describe some of these factors in new widowers and to compare them with those in married men. A community sample of 113 widowers bereaved less than 12 months and a family practice clinic sample of 111 married men matched for age were compared on five psychological and social measures (General Health Questionnaire, Beck Depression Inventory, State-Anxiety Inventory, Social Adjustment Scale, and Social Support Questionnaire). The results indicate significantly more distress in the widowers than in the married men. Highly distressed widowers had more problems with work outside the home, housework, and spare time, and they were younger and less satisfied with their social support than less distressed widowers. Widowers younger than 65 years were significantly more depressed and anxious, and had more social adjustment problems than widowers older than 65. These findings may be useful for longitudinal or intervention studies of widowers and may be of value for primary health care providers.

Adaptation, Psychological↗
PubMedDate not supplied

A comparison of seasonal variation in birthweights between rural Zaire and Ontario.

We studied the birthweights in a rural area in Zaire over a ten-year period and found a significant seasonal variation. Also, we reviewed the birthweights in two areas of Ontario over a five-year period. One area was in an Ontario Metropolitan hospital doing more than 2000 deliveries per year. The other was in a rural area in southwestern Ontario doing about 500 deliveries per year. No statistically significant seasonal variation in birthweight was found in Ontario. The seasonal variation in Zaire was associated with change in expenditure of energy by the pregnant women, variation in food availability, and malaria.

Birth Weight↗