Public assessment of priorities for research: a citizens' jury.
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Humans↗
Biomedical subjects
Michael Calnan
Publications and source records attributed to Michael Calnan.
The publication process itself was the major cause of publication bias in genetic epidemiology.
OBJECTIVES: How do scientists in the field of genetic epidemiology see the problem of publication bias, what are the possible solutions and what particular pressures are they under that might either promote or prevent publication and other biases? STUDY DESIGN AND SETTING: An exploratory study of beliefs and practices among scientists working in the field of genetic epidemiology. A purposive sample of senior, genetic scientists was selected (N=6) and informants were interviewed face to face. RESULTS: There was some consensus that the issue of nonreplication might be particularly problematic in genetic epidemiology, and that publication bias could contribute to this. The informants suggested that the problem lay mainly with the publication process. Publication of negative results was seen as important but fraught with difficulties. CONCLUSION: Possible solutions included education of editors, and reviewers, dissemination of negative findings through Web sites or accessible data archives and pooling of data. However, none of these were perceived to be straightforward given the current pressures on the research industry.
Culture↗
Public trust in health care: a comparison of Germany, The Netherlands, and England and Wales.
This article describes public trust in health care in three European countries. Public trust is a generalised attitude, influenced by people's experiences in contacts with representatives of institutions, in its turn influencing how people enter these contacts. In general, people in Germany have less trust in health care, while people in England and Wales have the highest trust levels. Cultural differences between the three countries could be an important source of differences. That makes public trust a less straightforward candidate for use as indicator of the future oriented dimension of user views in an international, comparative performance framework.
Adult↗
'Medicine's next goldmine?' The implications of new genetic health technologies for the health service.
There is considerable uncertainty about the implications of the new genetics for health services. These are the enthusiasts who argue that molecular genetics will transform health care and others argue that the scope for genetic interventions is limited. The aim of this paper is to examine some of the questions, tensions and difficulties which face health care providers particularly in developed countries as they try to come to terms with the dilemmas raised by new genetic health care technologies (NGHTs). It identifies questions for research which may help the development of robust and flexible strategies for implementation.
Attitude to Health↗
Trust relations in health care--the new agenda.
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Delivery of Health Care↗
Researching trust relations in health care: conceptual and methodological challenges--introduction.
PURPOSE: The aim of this paper is to provide a rationale for examining trust in health care. DESIGN/METHODOLOGY/APPROACH: Conducts a review of the literature of trust relations in health care that highlighted that most empirical research has addressed threats to patient-provider relationships and trust in health care systems from the patient's perspective, but studies in the organisational literature suggests that trust relations in the workforce, between providers and between providers and managers, may also influence patient-provider relationships and levels of trust. FINDINGS: Suggests that trust is not primarily dispositional or an individual attribute or psychological state, but is constructed from a set of inter-personal behaviors or from a shared identity. These behaviors are underpinned by sets of institutional rules, laws and customs. RESEARCH LIMITATIONS/IMPLICATIONS: This introductory paper has presented some evidence from an international, comparative study but there is the need for further, more detailed investigation into why trust relations may vary in different health care systems. ORIGINALITY/VALUE: This introductory paper provides a rationale for examining trust in health care and a context for the different elements of trust.
Humans↗
Trust relations in health care: developing a theoretical framework for the "new" NHS.
PURPOSE: This paper seeks to address how and why trust relations in the NHS may be changing and presents a theoretical framework for exploring them in future empirical research. DESIGN/METHODOLOGY/APPROACH: This paper provides a conceptual analysis. It proposes that public and patient trust in health care in the U.K. appears to be shaped by a variety of factors. From a macro perspective, any changes in levels of public trust in health care institutions appear to derive partly from top-down policy initiatives that have altered the way in which health services are organised and partly from broader social and cultural processes. A variety of policy initiatives, including the introduction of clinical governance and the resulting use of performance management to scrutinise and change clinical activity, increasing patient choice and involvement in decision-making regarding their care, are examined for how they have changed the context for trust relations within the NHS. FINDINGS: It is argued that these policy initiatives have produced a new context for trust relations within the NHS, shifting the inter-dependence and distribution of power between patients, clinicians, and mangers and changing their vulnerability to each other and to health care institutions. The paper presents a theoretical framework based on current policy discourses which illustrates how new forms of trust relations may be emerging in this new context of health care delivery, reflecting a change in motivations for trust from affect based to cognition based trust as patients, clinicians and managers become more active partners in trust relations. The framework suggests that trust relations in all three types of relationship in the "new" modernised NHS might, in general, be particularly characterised by an emphasis on communication, providing information and the use of "evidence" to support decisions in a reciprocal, negotiated alliance. ORIGINALITY/VALUE: The paper examines the drivers for change in trust in health care relations in the U.K. and develops a theoretical framework for the emergence of new trust relations that can be subsequently explored through empirical research.
Health Care Reform↗
Trust relations in health care: an agenda for future research.
PURPOSE: The aim of this paper is to draw together suggestions for future research from the papers and from the discussion that took place at the workshop. DESIGN/METHODOLOGY/APPROACH: The suggestions are summarised under four broad themes. FINDINGS: At an international workshop on trust organised by the U.K. MRC Health Services Research Collaboration there was broad agreement that trust was still a salient issue in diverse health care contexts. The workshop proceedings identified a number of important questions for empirical research and several key conceptual, theoretical and methodological questions relating to trust that need to be addressed in support of or alongside this. The collection of papers in this volume starts to address some of these questions. ORIGINALITY/VALUE: Considers trust relations in health care from patient, clinical, organisational and policy perspectives.
Delivery of Health Care↗
Dignity under threat? A study of the experiences of older people in the United Kingdom.
Theoretical accounts have offered a general understanding of the social significance and importance of dignity and suggest that older age may threaten dignity by structuring and limiting the opportunities for participation and/or social recognition. Micro-sociological research has shown how older people negotiate their identity, in the face of its erosion by the aging body and disability and the domination of health and social care workers. These theoretical approaches inform the study presented here, which explores the meaning and experience of dignity for older people in their daily lives. Older people's accounts were elicited through a series of focus groups with participants living in England and Wales. Participants were selected according to predefined criteria to represent a range of different socio-economic and ethnic backgrounds, levels of fitness, and home circumstances. Personal identity and autonomy were the aspects of dignity most meaningful to the participants, and discussions tended to focus mainly on when personal identity and autonomy were threatened or violated in the context of the provision of health and social care. The authors discuss the extent to which older people's discourse on dignity resonates with the theoretical discourse.
Aged↗
Disabling musculoskeletal pain and its relation to somatization: a community-based postal survey.
BACKGROUND: Somatization (a tendency to report distress from somatic symptoms) is a little studied, but potentially important, confounder and effect modifier in occupational studies of musculoskeletal disease. AIMS: To assess the role of somatization as a risk factor for disabling regional pain. METHODS: A questionnaire was mailed to 4998 subjects of working age. Questions were asked about chronic and disabling pain in the past 12 months affecting the arm, low back, knee or combinations of these sites. Distress from physical symptoms was assessed using elements of the Brief Symptom Inventory and mental well-being was assessed using the short-form 36 (SF-36). Associations were examined by modified Cox regression and expressed as hazard ratios (HRs) with 95% confidence intervals (CI). RESULTS: Among 2632 responders, 24% reported chronic pain and 25% disabling pain at one or several sites. Risk of chronic or disabling pain increased strongly according to the number of somatic symptoms reported as bothersome. For example, the HR for chronic upper limb pain in those distressed by > or =2 somatic symptoms in the past 7 days versus none was 3.9 (95% CI 2.9-5.3), and that of disabling upper limb pain was 5.8 (95% CI 4.1-8.3). Similar patterns were found for the low back and knee, and there was a gradient of increasing risk according to the number of sites with disabling pain. In comparison, associations with SF-36 mental well-being score were weaker. CONCLUSION: Somatizing tendency should be evaluated as a possible confounder or effect modifier in studies of occupational risk factors for musculoskeletal pain.
Adult↗
A qualitative study exploring how GPs decide to prescribe antidepressants.
BACKGROUND: To influence GPs' prescribing policies and practices it is necessary to have an understanding of how they make decisions. The limited evidence available suggests that not only do GPs find making decisions about diagnosing and prescribing for depression problematic, but that decisions are severely constrained by lack of resources. As a result, it might be thought that GPs, in line with current guidelines, will inevitably prescribe antidepressants for patients presenting with symptoms of anxiety and depression. This study examines the accuracy of this view. AIM: To explore how GPs decide to prescribe antidepressants. DESIGN: Focus groups with self-selected GPs. SETTING: Bristol and the surrounding district. METHOD: Qualitative study of five focus groups with 27 GPs. RESULTS: GPs' decisions about whether an antidepressant would be an appropriate form of management are shaped by a set of rules based on 'clinical' and 'social' criteria. The preferred strategy is to 'wait and see', but antidepressants are prescribed earlier when symptoms are perceived to be persistent, unresolving, severe and 'classic'. Decisions to prescribe are also shaped by organisational constraints of time, lack of accessible alternative management options, cost of prescribing and perceived patient attitude. CONCLUSION: The evidence from this study provides little support for the view that GPs take the easy option of prescribing antidepressants in the face of uncertainty. Evidence suggests that the GPs' prescribing was cautious, which indicates that GPs would support the initiative of recent draft guidelines regarding watchful waiting. This guidance, however, needs to be clear about what constitutes mild depression and address the question of prescribing to patients who are experiencing social adversity. Furthermore, alternatives to antidepressants such as counselling would need to be readily and equitably accessible. In addition, GPs need to be convinced that alternatives to antidepressants are at least as effective for patients with so-called 'mild depression'.
Antidepressive Agents↗
How acceptable are innovative health-care technologies? A survey of public beliefs and attitudes in England and Wales.
There has been a continuing debate about the extent to which the public finds health-care technological innovation acceptable. The public's ambivalence about scientific medicine may have been exacerbated, more recently, by developments such as the introduction of the 'new genetics' with their associated ethical and social implications and the claims that public trust in health care and practitioners and, more widely, in society has been eroded. The aim of this paper is to examine public attitudes to a range of innovative health-care technologies to see whether (i) certain technologies are perceived as particularly problematic, and (ii) attitudes to new health-care technologies are associated more broadly with beliefs about science, trust in health care and social trust, and perceptions of the benefits and risks of complementary and alternative medicine versus orthodox (technological) medicine. These questions are examined through a statistical analysis of data collected in a national, postal survey of the adult population (n = 1187) in England and Wales. The results showed public ambivalence about new health-care technologies, although genetic technologies, as a whole, were not seen to be problematic and their acceptability depended on their ability to control serious diseases. However, there was a level of consistency in attitude across the different technologies. Those consistently against new health-care technologies were also more likely to be suspicious of science, and doubtful about the benefits of other established, orthodox technologies (screening; medications) and to have less trust in health and health-care practitioners.
Adolescent↗
Commentary: the people know best.
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Attitude to Health↗
Job strain, effort--reward imbalance, and stress at work: competing or complementary models?
BACKGROUND: The Demand Control Model (DCM) and the Effort Reward Imbalance Model (ERI) offer putative explanations of the relationship between stressful working conditions, job strain, and psychological and physical ill health. AIMS: The aims of this study are to: (a) compare the predictive powers of the two models for explaining perceived job stress and mental distress amongst workers as a whole, (b) identify whether a model which combines dimensions of the DCM and ERI might have more predictive power than either of them separately, and (c) ascertain whether the models make distinct contributions to explaining stress at work in specific occupational settings. METHODS: Statistical analysis was carried out on data collected from a cross-sectional postal survey of a random sample (n = 7,069), of the adult population in an urban area in Southern England. The analysis focused on the 4,135 respondents who were in paid employment. RESULTS: There was little support for combining the models as the combined model was dominated by the predictive power of dimensions from the ERI. However, the results also showed that the models or dimensions of the models made distinct contributions to explaining perceived work stress in different types of occupation. CONCLUSIONS: There is little evidence to support a combined model of work characteristics. The ERI appears to be the stronger of the two models although the DCM has explanatory value for specific occupations.
Cross-Sectional Studies↗
Dignity in older age: what do older people in the United Kingdom think?
BACKGROUND: Dignity is a complex concept and there is little empirical research to show how older people view dignity. This study, using qualitative methods, explored the concept of dignity from the older person's perspective. METHODS: 15 focus groups and two individual interviews were conducted in 12 different settings, with a total of 72 participants. Participants were purposively sampled to ensure a mix of socio-economic status, ethnicity, gender, age (65+) and level of fitness. Focus groups were audio-taped and transcribed. The method of constant comparison was used to analyse the data. RESULTS: There was strong evidence to suggest that dignity was salient to the concerns of older people. Dignity was seen as a multi-faceted concept: (i). dignity of identity (self-respect/esteem, integrity, trust); (ii). human rights (equality, choice); and (iii). autonomy (independence, control). Examples of dignity being jeopardised rather than being enhanced were given. A loss of self-esteem arose from being patronised, excluded from decision-making, and being treated as an 'object'. Lack of integrity in society meant that there was an inability to trust others and an increased vulnerability. Equality was an important issue but many felt that government policies did not support their rights. CONCLUSIONS: This work identifies the different ways dignity is conceptualised by older people. The evidence showed that person centred care for older people needs to be specifically related to communication, privacy, personal identity and feelings of vulnerability. It provides evidence for policy makers and professionals to tailor policies and practices to the needs of the older person.
Aged↗
Older people. Courtesy entitles.
A study of 72 people, with an average age of 72, showed that dignity--and lack of it--were key issues in their estimation of care. Concerns about lack of dignity centred on lack of privacy, mixed sex wards, forms of address and loss of independence. The study suggested that older people do not complain about care for fear of retaliation.
Aged↗
The changing public/private mix in dentistry in the UK--a supply-side perspective.
This paper examines the factors beyond NHS dentists' remuneration which may explain the variations in the public/private mix in general dental practitioners' workload in the UK. Given that NHS dentistry is subject to a fixed price system, the study focused mainly on non-income supply-side factors. Using data from a postal survey of a national random sample of dentists practising in the NHS in England in 1997, the study found that the strategies adopted by dentists in the management of NHS lists and the evidence that dentists spent significantly more time in private consultations compared with NHS consultations support concerns over equity of access to dental care and the quality of NHS dentistry. Dentists' attitudes to NHS and private dentistry revealed considerable ambiguity towards the NHS. While, on the one hand, the lack of sufficient demand for private dentistry emerged as a strong reason for remaining in the NHS, on the other, there was evidence that equity in access to dental treatment is still seen as an important principle. The implications of these findings in the context of recent discussion of the future of NHS dentistry are considered.
Adult↗
Ageing and public satisfaction with the health service: an analysis of recent trends.
One possible explanation for the positive relationship between age and public and user views of health care is that it reflects a generational effect and this relationship has changed over the last decade or so. The analysis carried out in this report examines the relationship between ageing and levels of satisfaction with the health service in the UK using pooled data from the British Social Attitudes Survey, 1983-99. At the descriptive level there is strong evidence of a positive trend between age and satisfaction with general practice and hospital services, and for how the NHS is run but not for NHS primary dental services. Also, when comparing 1983 with 1999 data, there is evidence of a shift down in satisfaction levels for all of these indicators with the widest gap in inpatient services. At the multivariate level there is some evidence to suggest that, over time, the older population value how the NHS is run and GP and dental services at a slightly higher rate compared with the younger population, but the effect is small. This 'age/cohort' interaction effect is, however, negative for inpatient and outpatient services. These findings show little evidence of marked changes in attitude among the elderly or that the elderly are becoming more critical and less positive in their attitude to health care in the UK. The theoretical and methodological implications of these findings are discussed.
Adult↗