Biomedical subjects

L McLellan

Publications and source records attributed to L McLellan.

At least 19 recordsLinked to original sources

PubMed2001

Needs of carers of severely disabled people: are they identified and met adequately?

OBJECTIVE: To examine the unmet needs of informal carers of community dwelling disabled people and to compare their perspectives to those of disabled people and nominated professionals. It was hypothesised that a poor recognition of carers' needs could have implications for carers' well- being and thus their ability to maintain their caring role. Need was defined as a service or a resource that would confer a health or rehabilitation gain. DESIGN: Face to face interviews with carers and disabled participants, telephone interviews with professionals (Southern England). Disabled participants had been selected randomly from two disability registers. MAIN OUTCOME MEASURES: The Southampton Needs Assessment Questionnaire (carers version), SF-36 (carers' health status). RESULTS: Carers experienced similar health status to people in the general population. The most frequently carer-reported unmet needs were for short breaks, domestic help and respite care. Carers who had reported unmet need for short breaks had significantly poorer levels of mental health and vitality (SF-36) than carers who had not reported this. Similar numbers of unmet carers' needs were reported by disabled participants, professionals and carers themselves. In terms of type of unmet needs, poor concordance between carers and disabled participants occurred in 52% of cases: carers reported more unmet needs than disabled participants for short breaks and domestic help. Poor concordance scores between carers and professionals occurred in 59% of cases: carers reported more unmet needs for short breaks than professionals and professionals reported more unmet needs for formal respite care. CONCLUSION: In line with recent legislation, carers' needs must be independently addressed and services, especially for flexible community support such as short break services, must be developed specifically to meet the needs of carers. Further research is warranted to evaluate whether recent legislation for carers has any effect on carers' well-being and ability to cope with their caring role.

Adolescent↗

PubMed2000

To what extent are the needs of severely disabled people met by community rehabilitation services? A follow-up study.

PURPOSE: To evaluate which needs of disabled people would be met over a one year follow-up period and to examine which factors would be predictive of identifying those people who had more needs met from those who had fewer needs met. METHOD: A follow-up study of a cohort of community dwelling disabled people (aged 16-65) from two NHS Health Districts in Southern England with contrasting patterns of rehabilitation provision, who had participated in a cross-sectional interview study one year previously which had assessed their met and unmet needs. The Southampton Needs Assessment Questionnaire was used to examine needs. Disability was evaluated with the OPCS Disability and Severity Scales and perceived health status with the SF-36. RESULTS: Participation rate at follow-up was 92 %. Of the 300 baseline unmet needs reported by 69 of the 77 participants 33% had been met at follow-up. People whose disability had increased more and/or whose mental health status had improved more had greater percentages of their baseline needs met. There was a non-significant trend for smaller percentages of baseline needs to be met in Basingstoke than in Southampton. CONCLUSIONS: At ground level, disabled people's views were taken into account, to some extent, in the provision of rehabilitation services. This input should be made at a higher level, in the overall shaping of services.

Adolescent↗

PubMed2000

Met and unmet needs reported by severely disabled people in southern England.

PURPOSE: To examine the met and unmet needs for rehabilitation of disabled people living in the community in Southern England. METHOD: A cross sectional interview study of people with a primary physical disability, aged 1665. Disabled people were randomly selected from two existing disability registers, which comprised disabled people who had been identified by community rehabilitation services as being in need of regular surveillance by formal assessment of their care needs. A new semi-structured needs assessment questionnaire was developed and validated for the study (the Southampton Needs Assessment Questionnaire, SNAQ). Level of disability was examined with the OPCS Disability and Severity Scales. RESULTS: Ninety three disabled people participated. Their median (IQR) OPCS score was 8 (6-10). Participants reported a median (IQR) of three unmet needs (2-7). The most prevalent unmet needs were for adaptations, equipment, physiotherapy and wheelchairs, rather than unmet needs for intellectual and social fulfilment. CONCLUSIONS: Disabled people who were already in touch with community rehabilitation services continued to express unmet needs for further services. Meeting the more basic needs relating to people's housing, equipment, physiotherapy and wheelchairs may enable them to be more independent and fulfilled in other areas of their lives.

Activities of Daily Living↗

PubMed2000

Health promotion needs of young people with disabilities--a population study.

PURPOSE: Few research studies have sought to examine the health promotion needs of young people with disabilities. This paper reports the association between self-reported disability and various health behaviours (tobacco and alcohol use, physical activity, sedentary activities) psycho-social outcomes and school satisfaction. METHOD: Cluster stratified random sampling was combined with a cross-sectional descriptive design to obtain 3918 school students attending year 6 (primary school), year 8 and year 10 (high school) throughout New South Wales (Australia), to complete a self-administered questionnaire. RESULTS: The prevalence of self-reported disability among this student sample was 5.8%. The most frequently reported disabilities were physical, sensory and learning disabilities. Students with disabilities reported similar health and educational outcomes as their able-bodied peers. However, they also reported lower levels of school satisfaction, greater voluntary absenteeism and were more likely to get drunk or smoke cigarettes. Students with disabilities reported higher levels of psycho-social distress. They were also as physically active as other students, but also spent more time engaged in sedentary activities. CONCLUSION: Students with self-reported disabilities exhibit attitudes and behaviours that are consistent with studies of students who are alienated from their school communities. Community-based health promotion interventions are required to address these issues in order to prevent the onset of secondary disease processes or additional disability.

Adolescent↗

PubMed2000

Social factors associated with ethnic differences in alcohol and marijuana use by Vietnamese-, Arabic- and English-speaking youths in Sydney, Australia.

OBJECTIVE: To describe the use of marijuana and alcohol among Arabic- and Vietnamese-speaking senior school students compared with English-speaking background senior school students in Sydney Australia. METHOD: A quantitative survey of 2573 school students attending Years 10 and 11 from 12 high schools with a high Vietnamese and Arabic population was conducted in Sydney in 1998. Self-reported marijuana use, school and cultural background information was collected. RESULTS: Students from an English-speaking background, both males and females, had almost double the prevalence of marijuana use (once or more) during their lifetime (48.3 and 43.6%), the 12 months (40.9 and 36.3%) and 1 month prior to survey administration (23.1 and 13.4%) than the group with the second highest frequency of use (students of European and other backgrounds). Female Vietnamese (7.3% lifetime use) and Arabic students (8.6% lifetime use) had the lowest marijuana use rates, which were less than half that of male Vietnamese (23.5% lifetime use) and Arabic students (28% lifetime use). A similar pattern was found for three types of alcohol use. Spending three or more evenings a week out with friends was associated with higher alcohol use for Vietnamese students (relative risk ratio of 2.76). CONCLUSIONS: These results confirm lower marijuana and alcohol use among students from Vietnamese- and Arabic-speaking backgrounds compared with students from an English-speaking background. Harm minimization strategies may be learned from some migrant communities.

Acculturation↗

PubMed2000

Validation of the Frenchay Activities Index in a general population aged 16 years and older.

OBJECTIVES: To assess the validity and reliability of the Frenchay Activities Index (FAI) and to establish age and sex norms in people at or over the age of 16 years. DESIGN AND SETTING: Postal questionnaire survey to 1280 people randomly selected from 8 Health Authority patient registers in England. MAIN OUTCOME MEASURES: FAI scores, subscale scores by age and sex, health status, perceived level of activity, and subjects' opinions on how well the FAI reflected their activities. Test-retest reliability was measured in 1 Health Authority. RESULTS: The response rate was 49%. Men scored lower than women overall and on the domestic activities subscale. Respondents between the ages of 16 and 24 years and those over 85 years had the lowest FAI scores. FAI scores were related to self-reported health status, self-reported levels of activity, and presence of long-standing illness/disability. The FAI has high test-retest reliability. Qualitative data suggested that items such as sport, physical exercise, and caring for children should be included to make the FAI suitable for a wider age range. CONCLUSION: The FAI has good construct validity, particularly in middle-aged and elderly people, and is reliable. For the FAI to be valid in nonstroke populations, items specific to younger people must be incorporated into it. We have established preliminary age and sex norms that should be interpreted with caution, given the low response rate.

Activities of Daily Living↗

PubMed2000

Disabled people and professionals differ in their perceptions of rehabilitation needs.

BACKGROUND: This study set out to explore whether there are systematic differences in unmet needs for rehabilitation services and resources as identified by disabled people and nominated key professionals. METHODS: A cross-sectional interview survey of 87 pairs of community-dwelling disabled people (aged 16-65) and their nominated key professionals was conducted in southern England. The Southampton Needs Assessment Questionnaire (SNAQ) was used to examine unmet needs and the Office of Population Censuses and Surveys (OPCS) Disability and Severity Scale to examine level of disability. RESULTS: Eighty-seven pairs of disabled people and their nominated key professionals participated. People were severely disabled (median OPCS score 8; interquartile range 6-9). Disabled participants reported significantly more unmet needs than did professionals. There was zero concordance on identified unmet needs between disabled participants and professionals in 56 per cent of cases. Concordance between disabled participants and professionals was significantly better if the disabled participant had reported more unmet needs. There was a trend for general practitioners to be poorer at reporting disabled participants' needs than other professionals. There was fair agreement between disabled participants and professionals in five areas of unmet need only (in descending order): adaptations, physiotherapy, equipment, assistance with 'non-care' activities and the use of a day centre. In all the other areas of unmet need the agreement was poor. CONCLUSIONS: Needs for rehabilitation services and resources (for disabled people) are perceived differently by disabled people and professionals. Until we know who is right about rehabilitation needs, it is important to determine both users' and providers' views when planning and commissioning services.

Adolescent↗

PubMed2000

Factors associated with delayed tobacco uptake among Vietnamese/Asian and Arabic youth in Sydney, NSW.

OBJECTIVE: To describe the smoking behaviour and possible reasons for delayed uptake of tobacco smoking among Arabic and Vietnamese/Asian speaking senior school students in Sydney METHOD: A descriptive study involving four adult in-depth interviews and five student focus groups plus a quantitative survey of 2,573 school students attending Years 10 and 11 from 12 high schools with high Vietnamese and Arabic populations was conducted in Sydney in 1998. Self-reported smoking behaviour and peer, parent, school and cultural background information was collected. RESULTS: Students who smoke were more likely to have more than $20 a week pocket money, be from an English-speaking background, have no rules at home about smoking, have family members who smoke, not feel close to their father, spend three or more evenings a week out with friends, and have negative perceptions of the school environment and of the level of teacher support. They were less likely to smoke if they perceived their peers to be unsupportive. CONCLUSIONS: These results confirm the delayed uptake of smoking among students from a Vietnamese/Asian and Arabic-speaking backgrounds compared with those from an English-speaking background. A number of family and school factors were associated with smoking. IMPLICATIONS: Positive parental modelling, active parenting including awareness of or supervision of student leisure time, strict rules about not smoking and less pocket money are important strategies for preventing smoking among all adolescents.

Acculturation↗

PubMed2000

The Southampton Needs Assessment Questionnaire (SNAQ): a valid tool for assessing the rehabilitation needs of disabled people.

OBJECTIVE: To validate the Southampton Needs Assessment Questionnaire (SNAQ) for use with disabled people during face-to-face interviews. DESIGN: The SNAQ was designed to be used in a cross-sectional survey of disabled people with a physical disability with a follow-up study one year later. Content and criterion validity was examined using 32 disabled people who took part in the pilot study. Construct validity and internal reliability was examined using data from 93 disabled people who took part in the main survey. Responsiveness of the questionnaire was evaluated using the data gathered during a follow-up study of 77 people had taken part in the original study. OUTCOME MEASURES: The OPCS Disability Severity Scales (OPCS) and the Functional Independence Measure (FIM) were used to measure level of disability of participants, the Nottingham Health Profile (NHP) and the UK version of the SF-36 to examine perceived health status. PARTICIPANTS: People with a primary physical disability, aged 16-65, randomly selected from two disability registers in southern England. MAIN RESULTS: Content and criterion validity were established. Construct validity and internal reliability of the SNAQ was good. Inter-rater reliability was not tested since only one researcher conducted the interviews. Test-retest reliability was not formally tested because of the probability that participants would learn from the first needs assessment questionnaire and that different results on a retest occasion could arise from this. The SNAQ was sensitive in picking up changes over time. CONCLUSION: The SNAQ has shown good validity (content, coverage and construct), internal reliability, sensitivity and responsiveness. Further studies are needed to define the consequences of meeting or not meeting the rehabilitation needs of disabled people. Inter-rater reliability remains to be established.

Adolescent↗

PubMed1999

Bullying behaviour and psychosocial health among school students in New South Wales, Australia: cross sectional survey.

OBJECTIVES: To examine the prevalence of bullying behaviours in schoolchildren and the association of bullying with psychological and psychosomatic health. DESIGN: Cross sectional survey. SETTING: Government and non-government schools in New South Wales, Australia. PARTICIPANTS: 3918 schoolchildren attending year 6 (mean age 11.88 years), year 8 (13.96), and year 10 (15.97) classes from 115 schools. MAIN OUTCOME MEASURES: Self reported bullying behaviours and psychological and psychosomatic symptoms. RESULTS: Almost a quarter of students (23.7%) bullied other students, 12.7% were bullied, 21.5% were both bullied and bullied others on one or more occasions in the last term of school, and 42.4% were neither bullied nor bullied others. More boys than girls reported bullying others and being victims of bullying. Bullying behaviour was associated with increased psychosomatic symptoms. Bullies tended to be unhappy with school; students who were bullied tended to like school and to feel alone. Students who both bullied and were bullied had the greatest number of psychological and psychosomatic symptoms. CONCLUSIONS: Being bullied seems to be widespread in schools in New South Wales and is associated with increased psychosomatic symptoms and poor mental health. Health practitioners evaluating students with common psychological and psychosomatic symptoms should consider bullying and the student's school environment as potential causes.

Adolescent↗

PubMed1999

Health behaviour and the school environment in New South Wales, Australia.

The relationship between the school environment and health has infrequently been examined. This study sought to examine the association between school students' perceptions of their school environment, teachers' and peers' support and their health behaviours. A cross sectional descriptive survey by supervised self-administration was conducted in 1996 based on the international WHO collaborative survey of school children's health and lifestyle (the HBSC Study) and extended in an Australian setting. Randomly sampled primary and secondary schools from Catholic, Independent and Government education sectors throughout New South Wales (NSW), Australia, were invited to participate. The final sample included 3918 school students attending Year 6 (primary school), Year 8 and Year 10 (high school) from 115 schools. The main outcome measures were self-reported health status and 7 health behaviours (tobacco use, alcohol use, physical activity, dental hygiene, nutritional intake, seat belt and bicycle helmet use). Independent variables included student perceptions of the school environment, perceptions of teachers' and peers' support. Girls, Year 6 students and students who have less than $19 a week to spend were significantly more likely to have positive perceptions towards their school environment, teacher(s) and peers. Students who had positive perceptions regarding their school environment and perceived their teachers as supportive were significantly more likely to engage in health promoting behaviours adjusting for age, sex and average weekly pocket money. A supportive peer environment was not associated with positive health behaviour. Health promotion practitioners need to consider the impact of the school environment on health behaviours of school students. In particular, practitioners should consider intervention models that improve the school environment as a key strategy within a health promoting school.

Adolescent↗

PubMed1999

Mastery of fundamental motor skills among New South Wales school students: prevalence and sociodemographic distribution.

Mastery of fundamental motor skills among children and adolescents is a potentially important contribution to satisfying participation in sports, games and other physical activities and may enhance the development of an active lifestyle. However, few attempts have been made to determine the prevalence of fundamental motor skill mastery among young Australians. The NSW Schools Fitness and Physical Activity Survey, 1997 (N = 5518) randomly selected schools proportionally from all three education sectors and selected students in Years 4, 6, 8 and 10. Performance on six fundamental motor skills (run, vertical jump, catch, overhand throw, forehand strike and kick) was assessed qualitatively. The prevalence of mastery and near mastery of each skill and mastery of each skill component is reported for boys and girls in each school year. The findings indicate that the prevalence of mastery and near mastery of each of the fundamental motor skills was generally low. There were no differences between students from urban or rural schools and the prevalence of skill mastery was directly associated with socioeconomic status more consistently among girls than among boys. Greater curriculum time and resourcing and training of teachers is required to increase the proportion of students who have mastered the skills fundamental to common sports, games and other physical activities.

Female↗

PubMed1999

Generic health status measures are unsuitable for measuring health status in severely disabled people.

OBJECTIVES: To assess the perceived health status of disabled people. DESIGN: Perceived health status was evaluated with the Short Form 36 Health Survey (SF-36) and the Nottingham Health Profile as part of a needs assessment project exploring systematic differences in unmet needs for rehabilitation as perceived by disabled people, carers and professional staff. Disabled participants completed these health status questionnaires, as part of a face-to-face interview in participants' own homes. SUBJECTS: Ninety-two disabled people aged 16-65, recruited into the study from two disability registers. OUTCOME MEASURES: The Office of Population Censuses and Surveys (OPCS) Disability Severity Scale, Nottingham Health Profile, SF-36. RESULTS: Ninety-six disabled people took part in this study. Four were later excluded because of overwhelming communication difficulties. Median OPCS category was 8 (interquartile range 6-9.75). The pain and physical mobility domains of the Nottingham Health Profile were not completed by 46/92 participants (50%) because many questions referred to activities that these people could not perform, particularly walking. The physical functioning domain of the SF-36 showed severe floor effects. It was not therefore possible to use these measures to test the effectiveness of services provided to disabled people, particularly in the areas of physical functioning and pain. CONCLUSIONS: There is a continued need to develop and test instruments that can measure the outcomes of rehabilitation in severely disabled populations.

Adolescent↗

PubMed1998

Methods of the NSW Schools Fitness and Physical Activity Survey, 1997.

Physical fitness, participation in physical activity, fundamental motor skills and body composition are important contributors to the health and the development of a healthy lifestyle among children and youth. The New South Wales Schools Fitness and Physical Activity Survey, 1997, was conducted to fill some of the gaps in our knowledge of these aspects of the lives of young people in New South Wales. The survey was conducted in February and March, 1997 and collected data on a randomly-selected sample of students (n = 5518) in Years 2, 4, 6, 8 and 10. Measures were taken on body composition (height and weight, waist and hip girths, skinfolds), health-related fitness (aerobic capacity, muscular strength, muscular endurance, flexibility), fundamental motor skills (run, vertical jump, catch, overhand throw, forehand strike and kick), self-reported physical activity, time spent in sedentary recreation, and physical education (PE) classes. The methods are described to assist in the development of surveys of other populations and to provoke debate relevant to the development and dissemination of standard approaches to monitoring the fitness, physical activity habits and body composition of Australian children and youth. Finally, we offer comments on some of the strengths and limitations of the methods employed.

Anthropometry↗

PubMed1998

Providing appropriate information to patients and carers following a stroke.

This paper reports on a study which sought to identify the information needs of patients and their informal carers at various stages post-stroke with the aim of developing a database from which individualized information packages could be provided. The study used in-depth qualitative interviews with a total of 31 interviewees (both patients and carers) to explore information needs at three different points post-stroke: during hospitalization; up to 1 month post-discharge; and 2-12 months post-discharge. The information needs identified related to: recovery, treatment and prognosis; practical caring tasks; social activities; and resources available in the community. The study indicated that the information needs of patients and carers following stroke are not currently met and a desire for individualized information was identified. It is concluded that it may not be possible to meet patients' and carers' desire for information about recovery and prognosis but that a customized database covering the other areas highlighted by this study would facilitate improved information provision. It is anticipated that the process of providing such packages would improve communication within the rehabilitation team.

Aged↗

PubMed1993

Bioethics: social work's response and training needs.

Hospital social workers (N = 255) from ten urban teaching hospitals in seven states were surveyed regarding their practice responses and training needs in bioethics. Responses to twenty-one practice situations in bioethics were analyzed in terms of levels of encountering ethical concerns, clinical participation and preparedness to handle ethical concerns. Whereas worker responses were greater in practice situations appearing more psychosocial than biomedical in nature, training needs were greater in those situations appearing more biomedical than psychosocial in nature. Rationing of health care, the number one training need across service specialties, stands out as the practice situation in which ethical concerns were encountered with the least preparation and participation. Prior training in ethical principles and analysis and service on a hospital ethics committee associated significantly with higher levels of worker responses. Implications for social work education and practice in today's health care environment are presented.

Adult↗

PubMed1993

Provider-patient communication and metabolic control.

OBJECTIVE: To determine whether nurses' and NIDDM patients' communication styles during consultations are related to subsequent metabolic control and to examine factors influencing patterns of communication in these consultations. RESEARCH DESIGN AND METHODS: A total of 47 NIDDM patients participated in the study and completed the following procedures: 1) assessment of baseline HbA1, 2) attended 3.5 days of diabetes education, 3) returned in 1 mo for a follow-up consultation with a nurse, and (4) returned in 9-12 wk for a follow-up HbA1 assessment. The communication variables coded from the consultations were the frequency with which nurses produced controlling, informative, and patient-centered utterances and the frequency with which patients sought information, engaged in decision making, and expressed negative affect. RESULTS: The results were as follows: 1) patients experienced poorer metabolic control after interacting with nurses who were more controlling and directive in their communication with patients (r = 0.39, P < 0.01); 2) the nurses' use of patient-centered responses was directly related to the degree to which patients expressed feelings (r = 0.34, P < 0.01) and exhibited decision-making behavior (r = 0.62, P < 0.01); and 3) several of the nurses' and patients' communicative behaviors were related to patient characteristics such as age, sex, education, and baseline HbA1 levels. CONCLUSIONS: The results suggest that providers' attempts to exert considerable control during consultations with NIDDM patients may be counterproductive and contribute to poorer outcomes. The findings also indicate that patient-centered behaviors (e.g., encouraging the patient's involvement, respecting the patient's opinion, and offering support) facilitate the patient's ability to be an active participant in the consultation.

Age Factors↗

PubMed1987

Amino acid sequences of cytochrome c-554(548) and cytochrome c' from a halophilic denitrifying bacterium of the genus Paracoccus.

The amino acid sequences of the cytochromes c-554(548) and c' from the moderately halophilic bacterium Paracoccus sp., I.A.M. 203 (= A.T.C.C. 12084, N.C.I.B. 8669) have been determined. Cytochrome c-554(548) consists of a single polypeptide chain of 83 residues, and dimerizes strongly. The most similar protein of known sequence is the N-terminal half of the dihaem cytochrome c4, and other related proteins include the cytochrome c-554(547) of Thiobacillus neapolitanus and the cytochrome c-553 of Desulfovibrio vulgaris. Cytochrome c', which has a single polypeptide chain of 132 residues, is similar in sequence to cytochromes c' from phototrophic and denitrifying bacteria, but only shows about 36% sequence identity to the most similar protein of known sequence. Both of the Paracoccus proteins have a considerable excess of acidic amino acid side chains over basic ones, and a higher proportion of their basic amino acids is arginine than is usual in cytochromes c. Both these characteristics seem to be adaptations to increase the stability of the proteins in an environment of high ionic strength. Detailed evidence for the amino acid sequences of the proteins has been deposited as Supplementary Publication 50140 (24 pp.) at the British Library (Lending Division), Boston Spa, Yorkshire LS23 7BQ, U.K. from which copies are available on prepayment.

Amino Acid Sequence↗