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Biomedical subjects

M Wakefield

Publications and source records attributed to M Wakefield.

At least 55 records · Page 3Linked to original sources
PubMed1998

Effects of a smoking cessation program for pregnant women and their partners attending a public hospital antenatal clinic.

This study aimed to assess the effect of a hospital-based smoking cessation intervention delivered by midwives during routine antenatal and postnatal care on the smoking habits of pregnant women and their partners. At the first antenatal visit, women in the intervention group (n = 110) were given a demonstration of the immediate effects of smoking on foetal heart rate, brief smoking cessation advice and smoking cessation booklets for themselves and their partners; at delivery, they were given brief advice and a booklet about postpartum cessation. Compared with an historical control group who received usual care (n = 110) and assuming those lost to follow-up continued to smoke, biochemically-verified maternal cessation sustained from at least 24 weeks gestation to late pregnancy was 6.4% in the intervention group and 1.8% in the comparison group. However, there was no difference between maternal quit rates at six months postpartum. Partners were more likely to try to quit in the intervention group, but quit rates did not differ. Exposure to the intervention was not associated with increased levels of psychological distress, as measured by the 12-item General Health Questionnaire. We conclude that this type of intervention, when implemented by staff during routine care, is probably associated with a small improvement in maternal cessation in pregnancy, similar to that produced by minimal advice to quit smoking.

Adult↗
PubMed1997

Drug quantitation on a benchtop liquid chromatography-tandem mass spectrometry system.

The specificity and selectivity of LC-MS-MS is illustrated to explain why LC-MS-MS has become the method of choice for quantitation within the pharmaceutical industry. Two assays are described that demonstrate the facility with which new ion trap technology can utilize the selectivity and sensitivity of LC-MS-MS to quantitate trace level components within complex matrices, in particular human plasma. One assay undergoes a validation procedure and demonstrates the utility of this new technology for drug quantitation within a regulated environment.

Calibration↗
PubMed1997

Asthma prevalence, morbidity and management practices in South Australia, 1992-1995.

BACKGROUND: The Spring South Australian Health Omnibus Survey (SSAHOS) has been used to monitor trends in asthma prevalence, asthma morbidity and asthma management practices between 1992 and 1995. AIMS: To determine if self-reported asthma prevalence and availability of asthma action plans were increasing. To identify deficiencies in asthma management and opportunities for intervention. METHODS: Representative population survey by trained interviewers using a multistage, systematic, clustered area sample of 4200 households in South Australia where people aged 15 years or more are living. RESULTS: Over 3000 interviews were conducted each year. Between 1992 and 1995 the self-reported prevalence of asthma in those aged 15 years or more increased significantly from 15.7% to 20.3% (p < 0.0005), and the prevalence of current asthma increased from 9.3% to 11.4% (p < 0.05). The self-reported availability of individual asthma action plans increased from 21.9% in 1992 to 42.2% in 1995 (p < 0.0005). In 1992, 21% had a nebuliser at home, and 10.5% had a peak flow meter. In 1993, 61.4% were using preventive medications, and 35% thought bronchodilators were 'preventer' medications. In 1994 and 1995, between 12.5% and 15.6% had nocturnal awakening weekly or more often, and 31.4% had morning asthma symptoms weekly or more often. Between 20.1% and 20.8% had lost days from usual activities during the last year. Those on incomes below $20,000 had more symptoms, had more admissions to hospital, and required more medication than those on higher incomes. CONCLUSIONS: Self-reported asthma prevalence has increased. There remains a gap between current asthma management and that recommended by the National Asthma Campaign.

Adolescent↗
PubMed1997

Risk factors for repeat attendance at hospital emergency departments among adults and children with asthma.

BACKGROUND: Acute asthma attacks are frequent causes of attendance at hospital Emergency Departments (EDs) and a subgroup of these patients repeatedly present for such treatment. AIMS: This study sought to characterise patients who were repeat attenders at EDs, to assist the targetting of appropriate future interventions aimed at reducing avoidable presentation. METHODS: A cross-sectional survey was undertaken of patients presenting with an asthma attack to the EDs of six teaching hospitals in Adelaide, South Australia between 14 May and 30 June 1994. Patients were interviewed within six weeks of their attendance about aspects of their asthma history, severity, medications, self-management, attitudes and environment. Repeat attenders, defined as two or more visits over the course of the preceding year, were compared with those who reportedly attended on one occasion only, using logistic regression analyses. RESULTS: Sixty-two per cent of 272 patients aged under 15 years and 40% of 165 patients aged 15 years or more reported having attended two or more times over the course of the preceding year. Among adults, the variables independently associated with repeat attendance principally related to asthma severity. Among children, repeat attendance was associated with parental attitudinal variables relating to appraisal of their child's asthma severity, management of asthma attacks and parental worry. CONCLUSIONS: The factors underlying repeated presentations at EDs differ between adults and children and interventions to minimise avoidable presentation will require different emphasis for these patient subgroups.

Adolescent↗
PubMed1997

A risk screening questionnaire for adult asthmatics to predict attendance at hospital emergency departments. South Australian Asthma Reference Panel.

STUDY OBJECTIVES: To develop a practical screening tool that could identify adult patients highly likely to attend a hospital emergency department (ED) in a 1-year period. DESIGN: Retrospective case-control study of patients who did and did not attend a hospital ED for asthma in the past year. SETTING: Adelaide, South Australia. PARTICIPANTS: One hundred sixty-five adults attending an ED for asthma were compared with 260 adults with asthma from a community survey who had not attended an ED in the previous year. MEASUREMENTS AND RESULTS: The following variables were independently related to ED attendance: having been woken from sleep by asthma in past month; having been admitted to hospital because of asthma in the past year; having seen more than one general practitioner for asthma in the last 12 months; a moderate or severe self-rating of asthma in the last month; and having taken oral steroid medication for asthma in past month. A risk screening questionnaire using the weighted responses to these five variables with a cutoff score of 30/100 demonstrated a sensitivity of 90% and specificity of 88%. CONCLUSIONS: These findings agree with those of previous studies that markers of asthma severity and discontinuity of care are risk factors for adverse asthma outcomes. Validation of the risk screening questionnaire is required in a prospective study.

Adolescent↗
PubMed1997

New hope for a disabling condition. Cognitive-behavioral approaches to panic disorder.

1. Panic disorder, which encompasses both biological and psychological dimensions, is a common anxiety-related problem that can result in significant disability. 2. Cognitive-behavioral approaches to panic disorder are effective in 70% to 80% of patients treated, and generally involve a combination of patient education, relaxation training, exposure, and cognitive restructuring. 3. Mental health nurses can benefit their panic disorder patients by becoming aware of cognitive-behavioral treatment options, and should consider adding these methods to their repertoire of therapeutic skills.

Cognitive Behavioral Therapy↗
PubMed1996

Smoking behaviours and beliefs of older Australians.

Reviews of the effects of smoking on health have concluded that older smokers can experience considerable health benefits from giving up smoking. In a representative population survey of people aged 15 years and over in South Australia, the percentage of people aged 60 years and over who were smokers was 13.5 per cent (95 per cent confidence interval 10.9 to 16.2 per cent). Compared with smokers aged under 60 years (n = 727), older smokers (n = 88) were significantly more likely: to be less convinced of the effects of smoking on health; to perceive that they were not personally at risk from their smoking in the future; to believe that smoking had not affected their own health so far; and to believe there was a daily level of cigarette consumption that was safe. Strategies to encourage older people to consider more objectively how smoking impairs daily living, including personal disclosure of smoking-related damage through lung-function testing, deserve further research.

Adult↗
PubMed1996

Trends in prevalence and acceptance of workplace smoking bans among indoor workers in South Australia.

OBJECTIVE: To compare the reported prevalence and acceptance of bans on smoking in the workplaces of a representative sample of adults in South Australia between 1989 and 1994. DESIGN: Independent cross-sectional representative population surveys. SETTING: South Australian population. PARTICIPANTS: Adults who indicated they were employed mainly indoors, for the years 1989 (875 respondents), 1991 (1472), 1992 (1288) and 1994 (1273). MAIN OUTCOME MEASURES: Percentage reporting total bans on smoking at work; percentage reporting compliance with bans all or nearly all the time; percentage reporting preference for total bans at work. RESULTS: The percentage of indoor workers subject to a total ban on smoking at work increased from 32% in 1989 to 62% in 1994 and preference for a total ban increased during the same period from 26% to 52%. Reported compliance with restrictions and bans was very high. In 1994, 16% of workers still had no restrictions on smoking at work, but only 3% preferred this arrangement. CONCLUSION: The data suggest that smoking bans are now the norm for indoor workers and that further gains in promoting and supporting workplace bans will be made by directing efforts at smaller workplaces, where unrestricted smoking is most prevalent.

Adult↗
PubMed1995

Low-rate smokers.

BACKGROUND: Some smokers maintain a low daily smoking rate and do not appear to be addicted to nicotine (tobacco "chippers"). In a context of increasing social and environmental constraints on cigarette smoking, it is of interest to determine the population prevalence and the characteristics of low-rate smoking behavior. METHODS: A representative population survey was used to determine the prevalence and the correlates of low-rate smoking (five or less cigarettes a day). A range of sociodemographic, contextual, cognitive, and smoking-behavior variables was examined. RESULTS: Of 697 smokers age 20 years and over who had smoked for more than 2 years, 8.2% smoked five or less cigarettes a day; their average age was 39 years, and half were under 35 years of age; 88% had been smoking for 6 or more years; 86% were in the contemplation or preparation stages of readiness to quit. The significant independent predictors of being a low-rate smoker, compared to smoking at a higher daily rate, were perceiving quitting as not very difficult, smoking the first cigarette of the day more than 30 min after walking, buying packets of 30 or less cigarettes, and having not been advised by a doctor to quit. CONCLUSIONS: There were few differences between low-rate and other smokers on the range of variables that we were able to assess in a population survey. Since there is no safe level of cigarette smoking, medical advice to quit and public-education campaigns could target low-rate smokers specifically. Such initiatives could make significant contributions to reducing overall smoking prevalence.

Adult↗
PubMed1995

Smoking-related beliefs and behaviour among adults with asthma in a representative population sample.

BACKGROUND: Smoking and exposure to environmental tobacco smoke are inadvisable for adults with asthma. AIMS: To determine the smoking prevalence and daily smoking rate of asthmatics and compare smoking-related beliefs and behaviours among smokers with and without asthma. To compare beliefs of asthmatics about passive smoking and asthma, how many are exposed at home and what they do when they are exposed, with people who do not have asthma. METHODS: A representative population survey of 3019 South Australian adults aged 15 years and older interviewed in their own homes in late 1992. RESULTS: Twenty-eight per cent of asthmatics were smokers; mean daily smoking rate was 17.6. Asthmatics had similar patterns of smoking, readiness to quit and quit attempt histories as people without asthma. More than 40% of smokers with asthma did not perceive that smoking had greatly affected their health, over half did not believe they were at risk in future and two-thirds did not think future health problems would be serious. Among non-smokers, despite being more convinced of the effects of passive smoking on asthma, and being more concerned about exposure, those with asthma were no more likely to take protective action in response to actual or imminent exposure than those without asthma. One in ten non-smokers with asthma were exposed to smoking at home. CONCLUSIONS: The smoking habits of adults with asthma are cause for concern, with many asthmatic smokers perceiving they are not personally at risk from their smoking. Health education principles should be used by health professionals caring for asthmatic smokers to guide the selection and delivery of smoking cessation strategies. Prevailing restrictions on indoor smoking play an important role in protecting the respiratory health of non-smokers with asthma.

Adolescent↗
PubMed1995

Smoking-related beliefs and behaviour of South Australians with diabetes.

Data cumulated from three representative population surveys (n = 9402) in South Australia were used to determine smoking prevalence of those aged 15 years or over with and without self-reported medically confirmed diabetes. Overall, smoking prevalence in the two groups did not differ. However, among those aged under 40 years with self-reported diabetes, smoking prevalence approached 55 per cent, which was significantly higher than in young respondents without diabetes (32 per cent). Diabetic smokers were no more likely than were nondiabetic smokers to have tried to quit or to be ready to quit; one-quarter of diabetic smokers had no thought of quitting or of modifying their habit. Smokers with diabetes were significantly more likely to be heavy smokers (43.5 per cent) than were nondiabetic smokers (23.4 per cent). Fewer smokers with diabetes tended to believe that smoking causes or aggravates heart disease or circulatory problems than did other smokers, although these differences did not reach statistical significance. Additional effort is required to find methods to assist people with diabetes to refrain from smoking.

Adolescent↗
PubMed1994

Cardiovascular risk factors in South Australians with diabetes.

This study ascertained the prevalence of diabetes and compared the prevalence of cardiovascular risk factors among people with and without diabetes. Data were collected as part of the South Australian Health Omnibus Survey which involved a representative population sample of 6398 adults in metropolitan and country South Australia who were interviewed in their own homes. The self-reported prevalence of diabetes was found to be 3 per cent overall. This varied from approximately 1 per cent in the 15- to 39-year age group to 10.5 per cent in people aged over 80 years. Those with diabetes had a higher prevalence of cardiovascular risk factors than those without diabetes. There is a need for improved vigilance with people who have diabetes and interventions to modify the risk factors associated with cardiovascular disease.

Adolescent↗
PubMed1993

Attitudes of surviving relatives to terminal care in South Australia.

To provide evidence concerning caregivers' perceptions and experiences of terminal care service delivery in South Australia for a State Parliamentary Select Committee on the Law and Practice Relating to Death and Dying, a structured interview was conducted with surviving caregivers 1 year or more after the death of a family member. One hundred caregivers of deceased patients from metropolitan Adelaide were identified from the South Australian Central Cancer Registry. The study included caregivers of patients who died at home (N = 18) or in a public hospital (N = 27), hospice (N = 22), private hospital (N = 19), or a nursing home (N = 14). Home-care services were rated as good to excellent in most cases. The main sources of dissatisfaction were delays in gaining access to medical care and lack of practical help, such as showering or lifting. In most cases, the institutional care provided to terminally ill patients was judged by relatives as being good to excellent. Relatives expressed greater levels of satisfaction with hospice care, probably reflecting the higher staff ratios available at these institutions. Most caregivers considered that the place of death was the right place for the patient to have died. Home deaths were characterized by the patient having expressed a wish to die at home, whereas institutional care was sought because it was perceived that there would be better control of problematic symptoms in the terminal phase of care. Access to medical care, especially in public and private hospitals, was a concern for a significant percentage of caregivers.(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude↗
PubMed1993

Characteristics associated with smoking cessation during pregnancy among working class women.

Although smoking prevalence among pregnant women is highest among those of lower socio-economic status, the factors associated with cessation in this high risk group are poorly documented. This paper reports on data from a survey of working class women in Nottingham and Coventry, who were interviewed 6 months after having delivered a baby. It compares the characteristics of the 32 women who quit smoking during their pregnancy and were still ex-smokers at the 6 month post-natal point, with 472 women who had continued to smoke during their pregnancy or had returned to smoking in the post-partum period. A logistic regression analysis revealed three variables that were independently associated with long term cessation-having previously quit for more than 1 week, having a non-smoking partner, and believing that the children of smokers are more likely to get infections. Among the most disadvantaged, an understanding of how close social ties and economic circumstances influence smoking behaviour is crucial, if we are to develop more effective smoking cessation intervention strategies for working class women.

Adolescent↗
PubMed1993

Attitudes to some aspects of death and dying, living wills and substituted health care decision-making in South Australia: public opinion survey for a parliamentary select committee.

This study aimed to provide evidence on community attitudes to certain death and dying issues in South Australia for a state parliamentary committee on the law and practice relating to death and dying. The following areas were studied: truth-telling, pain control, level of treatment, preferred place of death, rights of patients to refuse treatment, opinion about living wills and substituted health care decision making. A representative population survey of 625 households in metropolitan Adelaide and three major rural centres was made in August 1991, using personal interviews administered at home with one adult in each household aged over 18 years. A total of 462 (74%) adults completed the interviews. There was strong support for truth-telling by doctors about incurable cancer and impending death, although this was not universal. Fears of potential addiction, habituation, tolerance and impaired cognitive function as a result of analgesia for cancer pain were strongly expressed, particularly amongst those who reported least formal education. Those with experience of a death in the last eight years were most likely to consider the level of treatment offered to patients with incurable cancer to be inadequate, but 53% considered the level to be about right. Nearly 60% of respondents favoured death at home, but there was a trend for older people to favour death in hospital. Despite the existence of the Natural Death Act (1982), only 20% were aware that living wills were legal in South Australia. There was strong support for a medical power of attorney.

Adolescent↗
PubMed1992

Characteristics of heavy smokers.

BACKGROUND: Heavy smokers (those who smoke greater than or equal to 25 or more cigarettes a day) are a subgroup who place themselves and others at risk for harmful health consequences and also are those least likely to achieve cessation. Despite this, heavy smokers are not well described as a segment of the smoking population. METHODS: We used representative population data on 1,048 smokers to examine differences between heavy and lighter smokers (less than or equal to 24 cigarettes per day). RESULTS: Heavy smokers constituted 26.7% of all cigarette smokers. Compared with lighter smokers, heavy smokers were significantly more likely to be male, to be age 30 years or older, to smoke their first cigarette of the day within 30 min of waking, to perceive quitting as very difficult, to have little confidence in their ability to quit, to be less likely to report variation in their rate of smoking between work and leisure days, and to be less likely to be employed. CONCLUSIONS: Public health strategies which may particularly assist heavy smokers include stronger restrictions on smoking in public places, nicotine replacement therapies, and the use of segmentation research to more carefully target campaign messages to influence quit attempts and confidence.

Adult↗