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Biomedical subjects

Jenny Donovan

Publications and source records attributed to Jenny Donovan.

29 records · Page 2Linked to original sources
PubMed2003

Relationship between body mass and gastro-oesophageal reflux symptoms: The Bristol Helicobacter Project.

OBJECTIVE: To examine the relationship between body mass and gastro-oesophageal reflux in a large population-representative sample from the UK. DESIGN AND SETTING: Cross-sectional population-based study, as part of a randomized controlled trial of eradication of Helicobacter pylori infection, in Southwest England. Subjects In all, 10 537 subjects, aged 20-59 years, were recruited from seven general practices. Subjects provided data on frequency and severity of dyspeptic symptoms and anthropometric measurements were taken. MAIN OUTCOME MEASURE: Relationship between overweight (body mass index [BMI] >/=25 kg/m(2) and </=30 kg/m(2)) or obesity (BMI >30 kg/m(2)) and frequency and severity of heartburn and acid regurgitation. RESULTS: Body mass index was strongly positively related to the frequency of symptoms of gastro-oesophageal reflux. The adjusted odds ratios (OR) for frequency of heartburn and acid regurgitation occurring at least once a week in overweight participants compared with those of normal weight were 1.82 (95% CI: 1.33-2.50) and 1.50 (95% CI: 1.13-1.99) respectively. Corresponding OR (95% CI) relating to obese patients were 2.91 (95% CI: 2.07-4.08) and 2.23 (95% CI: 1.44-3.45) respectively. The OR for moderate to severe reflux symptoms were raised in overweight and obese subjects but not to the same extent as frequency of symptoms and only the relationship between obesity and severity of heartburn reached conventional statistical significance: OR = 1.19; 95% CI: 1.07-1.33. CONCLUSIONS: Being above normal weight substantially increases the likelihood of suffering from heartburn and acid regurgitation and obese people are almost three times as likely to experience these symptoms as those of normal weight.

Adult↗
PubMed2003

Reduced risk of atopic disorders in adults with Helicobacter pylori infection.

BACKGROUND: Childhood infections may be necessary to prime the developing immune system in an appropriate manner. In developed countries, the incidence of childhood infections is decreasing, which might explain the observed rise in the prevalence of asthma and other atopic disorders in recent years. AIM: To determine whether Helicobacter pylori gastritis, a chronic bacterial infection that is usually acquired in early childhood and then persists throughout life, affects the risk of developing asthma and other atopic disorders. STUDY DESIGN: Cross-sectional study of the prevalence of three atopic disorders in 3244 subjects participating in a community-based, prospective, randomized, controlled trial of H. pylori eradication, the Bristol Helicobacter Project. The presence or absence of active H. pylori infection was determined by the 13C-urea breath test. The prevalence of asthma, eczema and allergic rhinitis was measured by assessing the use of appropriate medications as surrogate markers for these conditions. RESULTS: There was a 30% reduction in the prevalence of all three atopic disorders in people who had active H. pylori infection, although for each individual atopic disorder the numbers were not quite large enough to reach statistical significance. CONCLUSIONS: H. pylori infection is associated with a substantially reduced risk of three common atopic disorders. This is further indirect evidence of the importance of childhood infections in influencing the development of a normal immune response. As such infections become progressively less common in developed countries such as the UK, other methods will need to be developed to try to reduce the risk of atopic disorders.

Adult↗
PubMed2003

Including a 'no active intervention' arm in surgical trials is possible: evidence from the CLasP randomised trial.

OBJECTIVES: To examine the impact of including a 'no active intervention' arm (called 'conservative management') in a randomised controlled trial comparing treatments (including surgery) for men with lower urinary tract symptoms related to benign prostatic enlargement. METHODS: Outcomes 7.5 months after randomisation were acceptability of randomisation, overall acceptability of and satisfaction with conservative management, impact on quality of life, perceived need for further treatment and treatment failure (defined a priori). RESULTS: In total, 177 (out of 755) patients refused randomisation, including 31% who did not want surgery and 22% who wanted surgery. Most men randomised to conservative management were willing to undertake it as part of a trial but at the end of the trial they were divided between those who wanted to continue with it and those who expected surgery. At follow-up, 39% of conservative management patients requested surgery, and interference of symptoms with life and an unsuccessful outcome were more commonly reported in this arm. There were no appreciable differences between treatment groups in terms of treatment failures. CONCLUSIONS: Including a 'no active intervention' arm did not appear to have a detrimental effect on patient recruitment or the completion of this trial in the short-term; overall, conservative management was successfully completed by the majority of patients during the trial period, suggesting that researchers need not avoid including a no-intervention arm in surgical trials as long as they take care with its presentation.

Aged↗
PubMed2002

Quality improvement report: Improving design and conduct of randomised trials by embedding them in qualitative research: ProtecT (prostate testing for cancer and treatment) study. Commentary: presenting unbiased information to patients can be difficult.

PROBLEM: Recruitment to randomised trials is often difficult, and many important trials are not mounted because recruitment is thought to be "impossible." DESIGN: Controversial ProtecT (prostate testing for cancer and treatment) trial embedded within qualitative research. BACKGROUND AND SETTING: Screening for prostate cancer is hotly debated, and evidence from trials about the effectiveness of treatments (surgery, radiotherapy, and monitoring) is lacking. Mounting a treatment trial is controversial because of past failures and concerns that differences in complications of treatment but not survival make randomisation unacceptable to patients and clinicians, particularly for a trial including monitoring. STRATEGY FOR CHANGE: In-depth interviews explored interpretation of study information. Audiotape recordings of recruitment appointments enabled scrutiny of content and presentation of study information by recruiters. Initial qualitative findings showed that recruiters had difficulty discussing equipoise and presenting treatments equally; they unknowingly used terminology that was misinterpreted by participants. Findings were used to determine changes to content and presentation of information. EFFECTS OF CHANGE: Changes to the order of presenting treatments encouraged emphasis on equivalence, misinterpreted terms were avoided, the non-radical arm was redefined, and randomisation and clinical equipoise were presented more convincingly. The randomisation rate increased from 40% to 70%, all treatments became acceptable, and the three arm trial became the preferred design. LESSONS LEARNT: Changes to information and presentation resulted in efficient recruitment acceptable to patients and clinicians. Embedding this controversial trial within qualitative research improved recruitment. Such methods probably have wider applicability and may enable even the most difficult evaluative questions to be tackled.

Humans↗
PubMed2002

Quality of life assessment in men and women with urinary incontinence.

PURPOSE: The literature on assessment of quality of life from 1993 to 2001 was reviewed to evaluate and compare existing measures through their psychometric value and make adequate recommendations on their clinical use and future research. MATERIALS AND METHODS: We selected quality of life articles and abstracts from Current Content 1996 to 1997 and MEDLINE 1993 to 1996 for our first report presented at the first consultation on incontinence in Monaco in 1998. This report was then updated up to September 2001 using the same strategy. We made our recommendations based on our clinical and research experience with these tools. RESULTS: Several quality of life generic or disease specific questionnaires have been published for male and female urinary incontinence. However, their psychometric value is far from uniform and for most of them responsiveness is weak or has never been reported. CONCLUSIONS: Few quality of life questionnaires are at an advanced enough stage of development to be applied in clinical practice. However, even with these questionnaires more study remains to be done to make them shorter, sometimes even more specific and easier to use in different populations.

Female↗
PubMed2002

'The public is too subjective': public involvement at different levels of health-care decision making.

There are a number of impulses towards public participation in health care decision making including instrumentalist, communitarian, educative and expressive impulses and the desire for increased accountability. There has, however, been little research looking systematically at the public's preferences for being involved in particular types of rationing decisions, nor indeed, has there been a critical examination of the degree of involvement desired by the public. The research reported here uses findings from focus groups and in-depth interviews to explore these questions. Eight focus groups were conducted with a total of 57 informants, four amongst randomly selected members of the public and four with informants from health and non-health related organisations. Nineteen interviews were conducted to allow the elaboration of focus group comments, to probe views more deeply and to pursue emerging themes. The findings show variations in the willingness of members of the public to be involved in health care decisions and consistency across the different forms of the public as represented by the focus groups with randomly selected citizens and pre-existing organisations. There was a strong desire in all the groups for the public to be involved both at the system and programme levels, with much less willingness to be involved at the individual level. At the system and programme levels informants generally favoured consultation, without responsibility for decisions, but with the guarantee that their contribution would be heard and that decisions taken following consultation would be explained. At the patient level informants felt that the public should participate only by setting criteria for deciding between potential beneficiaries of treatment. The public has much to contribute, particularly at the system and programme levels, to supplement the inputs of health care professionals.

Attitude to Health↗
PubMed2002

"If there were a war tomorrow, we'd find the money": contrasting perspectives on the rationing of health care.

In spite of the substantial academic effort being devoted to the subject of health care rationing, there is little clarity about the views of those working in health care who have to implement rationing nor about the views of citizens who are (potentially) affected by the rationing of care. This paper reports the findings of a study conducted using focus groups and semi-structured interviews to explore and compare beliefs about rationing among citizens and those with a role in the health service (service informants) within the context of health care provision in the UK. Citizen and service informants both identified external pressures on the resources available for health care including technological improvement, the ageing population and increasing public expectations. Citizens, however, also identified such factors as the political choice to provide insufficient funds to the health service and the wasteful use of resources that are available. The predominant view was that these latter factors were amenable to change and thus that there are alternatives to the rationing of care. Some citizens accepted that some health care rationing might be necessary. Service informants, on the other hand, were cynical about prospects of increased funding and viewed further reductions in management as untenable. For them, rationing was an inevitability to be managed. A number of these informants felt that rationing should become more explicit, suggesting that openness made rationing both more democratic and more practical. Others, however, believed that explicit rationing would have a number of uncomfortable implications. The paper concludes by suggesting that if rationing is to become more explicit, its inevitability, as perceived by those working within health care, will have to be communicated to citizens.

Attitude of Health Personnel↗
PubMed2002

Our interest is swelling: a collaborative venture to establish the world's first free public screening for lymphoedema.

This article describes the collaborative processes involved in the implementation of a free public health screening program for people at risk of lymphoedema following the removal of lymph nodes during surgery to control breast, prostate and other cancers, or injury. The planning phase of the program is described with emphasis on the need to secure a well situated venue, the commitment of a cohort of key health professionals, service club and lay volunteers, and the need to carefully target and publicise the event widely. The implementation phase requires careful consideration of the physical layout of the event, the direction and management of the flow of human traffic, information and equipment requirements, and recognition that screening programs place people in vulnerable positions. Effective communication skills are essential, as is a knowledge of where people can be referred should the need arise. A budget is provided together with discussion regarding the success of the program and recommendations for future consideration such as the need to target men to attend screening and for long term follow up of the outcomes.

Australia↗
PubMed2002

Using meta ethnography to synthesise qualitative research: a worked example.

OBJECTIVES: To demonstrate the benefits of applying meta ethnography to the synthesis of qualitative research, by means of a worked example. METHODS: Four papers about lay meanings of medicines were arbitrarily chosen. Noblit and Hare's seven-step process for conducting a meta ethnography was employed: getting started; deciding what is relevant to the initial interest; reading the studies; determining how the studies are related; translating the studies into one another; synthesising translations; and expressing the synthesis. RESULTS: Six key concepts were identified: adherence/compliance; self-regulation; aversion; alternative coping strategies; sanctions; and selective disclosure. Four second-order interpretations (derived from the chosen papers) were identified, on the basis of which four third-order interpretations (based on the key concepts and second-order interpretations) were constructed. These were all linked together in a line of argument that accounts for patients' medicine-taking behaviour and communication with health professionals in different settings. Third-order interpretations were developed which were not only consistent with the original results but also extended beyond them. CONCLUSIONS: It is possible to use meta ethnography to synthesise the results of qualitative research. The worked example has produced middle-range theories in the form of hypotheses that could be tested by other researchers.

Anthropology, Cultural↗