Biomedical subjects

John R Attia

Publications and source records attributed to John R Attia.

7 recordsLinked to original sources

PubMed2006

Neuropsychological health in F-111 aircraft maintenance workers.

OBJECTIVE: To contrast subjective and objective measures of neuropsychological health in F-111 aircraft Deseal/Reseal maintenance personnel, against two appropriate comparison groups. METHODS: Exposed and comparison participants completed a postal questionnaire which included a validated memory questionnaire and additional questions relating to possible cognitive symptoms. They also underwent a comprehensive neuropsychological assessment and screening for a past or current disturbance of mood. Multiple linear or logistic regression was conducted for each outcome using exposure group and potential confounders as explanatory variables. RESULTS: There was a strong and consistent excess of self-reported cognitive problems among the exposed group relative to the comparison groups including a 2.8-4.3-fold increase in self-reported symptoms of forgetfulness, loss of concentration and difficulty finding the right word. On detailed neuropsychological testing, the exposed group performed significantly worse than comparisons on tests of psychomotor speed, executive functioning, and new learning/memory. These findings could not be accounted for by disturbances of mood or other potential confounders. CONCLUSIONS: There was a strong and consistent increase in self-reported cognitive problems among the exposed, and small but significant exposure-specific differences on objective tests of cognitive functioning. The findings are consistent with the development of adverse neuropsychiatric changes related to occupational exposure to solvents.

Adult↗

PubMed2006

Mental health in F-111 maintenance workers: the study of Health Outcomes in Aircraft Maintenance Personnel (SHOAMP) general health and medical study.

OBJECTIVE: We sought to contrast mood disorder symptoms in F-111 aircraft Deseal/Reseal maintenance personnel with appropriate comparisons. METHODS: Participants completed a comprehensive health assessment, including measures of mood disorder, self-reported mood symptom questionnaire items, and review of anxiolytic and depression medication. Multiple logistic regression was conducted for each outcome using exposure group and potential confounders as explanatory variables. RESULTS: There was high agreement between self-reported mood disturbance and objective tests. The exposed group was more likely to self-report previous diagnoses of depression/anxiety, had higher use of antidepressant medications, and had increased risk of diagnosis of depression/anxiety. Results were consistently strong against both comparison groups, with the exposed more likely to have mental distress and social dysfunction when compared with the Australian population. CONCLUSIONS: There is robust evidence for an association between F-111 Deseal/Reseal exposure and impaired mental health.

Aircraft↗

PubMed2004

Generating pre-test probabilities: a neglected area in clinical decision making.

OBJECTIVE: To assess the accuracy and variability of clinicians' estimates of pre-test probability for three common clinical scenarios. DESIGN: Postal questionnaire survey conducted between April and October 2001 eliciting pre-test probability estimates from scenarios for risk of ischaemic heart disease (IHD), deep vein thrombosis (DVT), and stroke. PARTICIPANTS AND SETTING: Physicians and general practitioners randomly drawn from College membership lists for New South Wales and north-west England. MAIN OUTCOME MEASURES: Agreement with the "correct" estimate (being within 10, 20, 30, or > 30 percentage points of the "correct" estimate derived from validated clinical-decision rules); variability in estimates (median and interquartile ranges of estimates); and association of demographic, practice, or educational factors with accuracy (using linear regression analysis). RESULTS: 819 doctors participated: 310 GPs and 288 physicians in Australia, and 106 GPs and 115 physicians in the UK. Accuracy varied from about 55% of respondents being within 20% of the "correct" risk estimate for the IHD and stroke scenarios to 6.7% for the DVT scenario. Although median estimates varied between the UK and Australian participants, both were similar in accuracy and showed a similarly wide spread of estimates. No demographic, practice, or educational variables substantially predicted accuracy. CONCLUSIONS: Experienced clinicians, in response to the same clinical scenarios, gave a wide range of estimates for pre-test probability. The development and dissemination of clinical decision rules is needed to support decision making by practising clinicians.

Adult↗

PubMed2003

Seasonal variation in stroke in the Hunter Region, Australia: a 5-year hospital-based study, 1995-2000.

BACKGROUND AND PURPOSE: Seasonal variation in stroke has long been recognized. To date, there are minimal published data on seasonal variations in rates of stroke and subsequent case fatality in the Southern Hemisphere. The aim of this study was to examine stroke seasonality through the use of data from a hospital-based stroke register in the Hunter Region of New South Wales, Australia. METHODS: From July 1, 1995, to June 30, 2000, 3803 stroke events were registered in residents of the Hunter Region, New South Wales, Australia. We analyzed the trend of seasonal and monthly stroke attack rates and case-fatality rates using Poisson regressions with age and sex as covariates. RESULTS: Stroke attack rates were highest in the winter and lowest in the summer. From February (summer) to July (winter), there was a significant trend in increasing stroke attack rates (rate ratio, 1.07; 95% confidence interval, 1.05 to 1.10; P<0.001). This increase was seen mainly in those >or=65 years of age. Case-fatality rates showed similar trends with a 1- to 2-month lag compared with attack rates. CONCLUSIONS: There is an increase in stroke attack rates and case-fatality rate from summer to winter in the Hunter Region, Australia. These trends are similar to those found in the Northern Hemisphere.

Adult↗

PubMedDate not supplied

Evidence-based physicians' dressing: a crossover trial.

OBJECTIVE: To describe the effect of physicians' dress on patient confidence and trust. DESIGN: A prospective crossover trial involving physicians dressed in "respectable" versus "retro" attire. SETTING: A general medicine ward at a tertiary hospital. PARTICIPANTS: 12 male general physicians and 1680 patients. MAIN OUTCOME MEASURES: Patient trust and confidence as measured by a questionnaire mailed after hospital discharge. RESULTS: Formal attire was correlated with higher patient confidence and trust. Nose rings were particularly deleterious to patients' reported trust and confidence. A minimum threshold of two items of formal attire (dress pants, dress shirt, tie, or white coat) were necessary to inspire a reasonable amount of confidence; this is the NND (number needed to dress). CONCLUSIONS: We highlight the need for more research into the effects of physician dress, and coin the term "evidence-based dressing".

Clothing↗

PubMedDate not supplied

Interns are from Venus, consultants are from Mars: differential perception among clinicians.

OBJECTIVE: To test for the presence of sex-based differences in perception (the notion that men and women "think" differently, and that differences in perception are biologically based) among healthcare professionals. DESIGN: Prospective survey. SETTING AND PARTICIPANTS: 90 medical personnel at a tertiary care hospital in Newcastle, NSW. INTERVENTION: Healthcare professionals were shown two pictures that could be interpreted as depicting either a young or an old person, and a word that could be seen as geometric shapes. MAIN OUTCOME MEASURES: The effects of sex, age, seniority, and specialisation in relation to the first impression of the image, the ability to change one's perception, and the speed of perception. RESULTS: Contrary to popular opinion, male physicians were more likely to perceive the older figures, and just as likely as women to be able to change their perception. Surgeons and junior staff were more likely to see, as well as being faster to form, an impression requiring abstract thought, and were more able to change their perceptions. CONCLUSIONS: Traditional sex stereotypes do not apply to medical personnel, but other age-based stereotypes, and professional rivalries (medical versus surgical) may have some empiric basis.

Adult↗

PubMedDate not supplied

Patient-oxygen dissociation curves: surveying the spectrum of oxygen-delivery methods.

OBJECTIVE: To describe the spectrum of oxygen-delivery methods. DESIGN: Clinical audit. SETTING: Medical wards of a tertiary referral teaching hospital in August 2004. PARTICIPANTS: 98 medical patients receiving supplemental oxygen. RESULTS: Of the 98 patients, 40 were not receiving oxygen by customary methods. In classifying the patterns of oxygen delivery, we describe the transcephalic, submental, and (inadvertent) rectal approaches, as well as lachrymal insufflation and the "Venturi cravat". We also describe novel oxygen-weaning methods, including the half-wean, reverse wean, and placebo wean. CONCLUSIONS: Many patients receive oxygen by unconventional methods. We postulate that this is evidence of a renewed interest in the historical routes of oxygen delivery.

Australia↗