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Biomedical subjects

M Cooke

Publications and source records attributed to M Cooke.

At least 19 recordsLinked to original sources
PubMed1996

An outbreak of Salmonella typhimurium DT104 food poisoning associated with eating beef.

An outbreak of Salmonella typhimurium DT104 infection in Shropshire in May 1995 was identified when four isolates were noted to be from members or supporters of a local football team that had held several social functions in the same week. The subsequent investigation identified 16 people with gastrointestinal symptoms and 12 with microbiologically confirmed infection. The outbreak was complex, associated with several social functions on different days, but infection was associated with eating beef at a public house. A number of errors were detected in the cooking, storage, and handling of the implicated food. The investigation identified beef as the vehicle of infection in this outbreak but was unable to show whether it was the original source of infection or whether cross or manual contamination occurred in the kitchen.

Animals↗
PubMed1996

Postbereavement depressive mood and its prebereavement predictors in HIV+ and HIV- gay men.

Prebereavement predictors of the course of postbereavement depressive mood were examined in 110 gay men who were their partner's caregiver until the partner's death of AIDS. In all, 37 HIV+ and 73 HIV- bereaved caregiving partners were assessed bimonthly throughout a 10-month period beginning 3 months before and ending 7 months after the partner's death. Throughout the 10 months, mean Centers for Epidemiology Scale-Depression (CES-D) scores on depressive mood were above the cutoff for being at risk for major depression. CES-D scores decreased for 63% bereaved caregivers over the 7 postbereavement months, and 37% showed little change from high CES-D scores or increasing CES-D scores. High prebereavement CES-D scores and finding positive meaning in caregiving predicted diminishing depressive mood; HIV+ serostatus, longer relationships, hassles, and use of distancing and self-blame to cope predicted unrelieved depressive mood.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Evaluation of a cognitive-behavioural intervention for pregnant injecting drug users at risk of HIV infection.

Pregnant injecting drug users were randomly assigned to: (i) individually receive a six-session cognitive-behavioural intervention in addition to their usual methadone maintenance treatment (intervention condition (I) (n = 40)); or (ii) their usual methadone maintenance treatment only (control condition (C) (n = 40)). There was no change in drug use per se in either group after the intervention. However, at 9-month follow-up the I group had significantly reduced some HIV risk-taking behaviours (in particular injecting risk behaviours). The I group reduced the needle risk associated both with "typical" use (drug use in the month before interview) and "binge" use (drug use in the month nominated as the heaviest month of drug use in the previous 6 months). The intervention had no effect on sexual risk behaviours. The finding of reduced injecting risk behaviour following the six-session intervention suggests that such an intervention may be of benefit for individuals persisting with injecting risk behaviours despite methadone maintenance treatment and the availability of sterile injection equipment.

Adult↗
PubMed1996

Nursing students' perceptions of difficult or challenging clinical situations.

This study examined students' perceptions of difficult or challenging clinical situations and how facilitators assisted students in relation to these specific situations. Responses to open-ended questions from first-year nursing students before and after a series of hospital and community nursing practice placements were analysed. The findings suggest that students do find certain clinical situations difficult or challenging and that facilitators can greatly assist students to effectively deal with these through specific teaching strategies.

Attitude of Health Personnel↗
PubMed1996

Physician responses to a hospital policy allowing them to not offer cardiopulmonary resuscitation.

OBJECTIVE: To determine whether physicians followed a hospital policy permitting them to not offer cardiopulmonary resuscitation (CPR) to patients considered unlikely to benefit from this therapy. DESIGN: Prospective series. SETTING: San Francisco General Hospital, a university-affiliated public hospital. PATIENTS: Attending physicians were interviewed about patients admitted over a period of 5 consecutive months for whom do-not resuscitate (DNR) orders were written. Only the first patient for whom each physician wrote a DNR order was included. MAIN OUTCOME MEASURES: Responses of physicians to questions regarding their initiation of DNR orders for these patients. RESULTS: Sixty-nine physicians responded to questions about DNR orders written for 69 patients. Fifty-seven of these physicians said that they were aware of the hospital policy, and 49 of the 57 physicians said that they generally agreed with it. Thirty-three physicians felt that CPR should be offered only to patients likely to benefit from it. In contrast, 36 physicians said that CPR should be offered to all patients, regardless of benefit. CPR was offered to 41 patients and 15 surrogates; 27 of these patients were considered to be unlikely to benefit from CPR. CONCLUSION: Despite a policy that allows them to do otherwise, physicians usually offered CPR to patients, regardless of benefit. Most physicians believed that CPR should be offered to all patients. These findings suggest that policies such as that of San Francisco General Hospital may not be compelling because physicians hold attitudes that are inconsistent with the policies.

Attitude of Health Personnel↗
PubMed1996

Spinal boards.

Explore the source record for details and available documents.

Accidents, Traffic↗
PubMed1996

The ethics of the health care market.

The free market theory has as its basis the assumption of equity. This equity is ascribed to both purchasers and providers in a perfectly balanced system so that there are seen to be no 'winners' or 'losers' in the market-place. The health system that is developing in the UK is structured as a managed market, but agency relationships between GPs and health authorities buffer the costing process of goods and therefore may be described as distorting the price. This could also be distorting the ability of the users, who are the real purchasers, from exercising their economic freedom. They may also lose the autonomy to choose goods that suit their particular needs, and equally not to choose those services that they do not want or wish to pay for vicariously (i.e. that the common good is respected by both providers and purchasers). This assumes that users of the service know the level of choice that they have and that not only are providers protected at present by the practices of the purchasers but also entry into the market for new providers is severely curtailed. The exercise of true freedom of the market in economic terms is one of moral obligation to provide services that not only have a market value that is affordable and a requirement of the 'common good' but also are historically acceptable for social requirements (i.e. that the services are valued as fundamental tenets of the rights of individuals in society). The expression of this need will therefore be utilitarian (i.e. the users of the services should benefit from them rather than the providers).

Choice Behavior↗
PubMed1996

Predictors of brief smoking intervention in a midwifery setting.

The aims of this study were: to assess current practice in smoking cessation interventions by midwives and to examine the relationship between the use of smoking intervention, practitioner characteristics and organizational factors. A mail-out survey was sent to a random sample of 500 midwives. The response rate was 85% (n = 425). The results indicated that most midwives used minimal interventions (advice and education) for at least some of their clients. However, the more skilled and more time-intensive forms of intervention such as counselling about methods to quit, negotiating a quit date and follow-up were infrequently utilized. Moreover, participants estimated that half their smoking clients were not offered any advice about smoking. Organizational factors such as: hospital policy for smoking intervention, type of hospital, size of hospital, cohesion of staff and work pressure predicted the use of smoking interventions. Self-reported ability to intervene for smoking and the level of assessment undertaken were practitioner characteristics which predicted the use of smoking interventions. The barriers that inhibit the use of smoking intervention by midwives are discussed and methods for change canvassed.

Adult↗
PubMed1995

The consequences of a positive prenatal HIV antibody test for women.

As more women of childbearing age are affected by the human immunodeficiency virus (HIV), many providers have demanded routine perinatal HIV screening, arguing that the medical benefits of testing outweigh the socioeconomic, medical, and psychological risks of a positive HIV test for women. In this primarily urban poor population, we used a semistructured interview to evaluate differences in health care discrimination, economic losses, risk behaviors, relationships changes, and psychological status in 20 HIV-positive and 20 HIV-negative mothers matched for HIV risk, race, income, and delivery date. Many (35%) seropositive and no seronegative women cited health care discrimination due to HIV status. Although seropositive women reported greater satisfaction with social support from friends (100%) and family (80%), many women had not disclosed their HIV status to any friends (65%) or family (25%), indicating fear of abandonment. Only 56% of HIV positive and 44% of seronegative women knew their partners' HIV status, and many HIV-positive and HIV-negative women reported having sex without condoms after the HIV test. Mean standardized anxiety (p < 0.05) and depression scores were higher in seropositive women. Despite added social support and medical treatments, HIV-positive women showed higher levels of health care discrimination, personal isolation, and psychological sequelae than their seronegative counterparts. As the medical benefits to prenatal HIV testing increase, we will need to develop focused medical, social, and mental health services addressing the needs of HIV-positive women.

Adult↗
PubMed1995

Automatic access of lexical information in Broca's aphasics: against the automaticity hypothesis.

A number of recent articles have claimed that the language comprehension impairments of so-called agrammatic patients can be characterized as being due to problems with the automatic access of semantic and/or syntactic information from the lexicon. We describe three experiments, all using tasks which probe the immediate and automatic access of lexical information and compare the performance of agrammatic patients with that of an anomic and a fluent patient. We find no evidence in support of the automaticity hypothesis as an explanatory account of the language deficits of agrammatic aphasics. Further, we argue that current research does not lend itself to a single-explanation account of agrammatic comprehension problems, and that in-depth analyses of individual patients are more likely to be fruitful in terms of understanding the nature of comprehension deficits.

Aged↗
PubMed1994

Ethical, behavioral, and social aspects of HIV vaccine trials in developing countries.

ISSUE: Several investigators are preparing to conduct efficacy trials of human immunodeficiency virus (HIV) vaccines in the developing world. Failure to adequately address the unique ethical, behavioral, and social issues that surround vaccine testing in that setting will jeopardize the success of these trials and future acquired immunodeficiency syndrome (AIDS) research in the host nation. DESCRIPTION OF THE PROJECT: Twelve investigators from Africa, Asia, North America, and South America reviewed previous experience with HIV trials in developing countries and explored potential solutions to these issues. CONCLUSIONS: Host country scientists, government officials, and media must be actively involved in all aspects of the trials. Minimum prerequisites for conducting the trial include the following: (1) researching vaccines active against developing world HIV isolates; (2) establishing and maintaining an adequate technological infrastructure; (3) assessing the feasibility of recruitment in countries where the existence of HIV may be denied; (4) designing methods to obtain informed consent from each individual subject, rather than exclusively from family members or community elders; (5) creating locally appropriate instruments to measure risk behavior; (6) identifying a behavioral intervention for placebo and treatment groups; (7) making available laboratory methods to distinguish between natural HIV infection and vaccine-induced seropositivity; and (8) guaranteeing that an effective vaccine is available free of charge to the placebo group and at affordable prices to other host country residents.

AIDS Vaccines↗
PubMed1994

Proficiency of internal medicine residents in outpatient care of patients with HIV infection.

To determine internal medicine residents' knowledge of HIV care, the authors conducted a survey of residents from four internal medicine programs in the San Francisco Bay area. On a knowledge test, the mean score was 42.4/55, 77% correct. The residents performed relatively worse on questions regarding didanosine and zalcitabine, tuberculosis prophylaxis, and risk of cervical neoplasia in HIV-infected women. Predictors of greater knowledge were specific residency program, higher postgraduate year, primary care residency track, and more extensive HIV experience. Primary care internal medicine residencies and programs with more exposure to HIV patients are most effective in producing knowledgeable residents.

Ambulatory Care↗