Biomedical subjects
N C Stott
Publications and source records attributed to N C Stott.
Day case surgery generates no increased workload for community based staff. True or false?
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Risk targeting in cervical screening: a new look at an old problem.
In the face of continuing debate about the level of effectiveness of the United Kingdom cervical cytology screening programme in preventing cervical cancer, more precise targeting of high risk groups might offer a means of enhancing its efficiency. Broad risk targeting is already practised by screening only sexually active women aged 20 to 65 years. This paper describes a risk scoring system constructed from the available literature and designed to be used by primary care health professionals and patients. The system involves four independent risk factors: educational level, current smoking habit, years of oral contraceptive use and number of sexual partners. Since the objective is simply to identify women at relatively high risk, inclusion of a factor neither requires nor implies causality. The next steps are to study the feasibility of putting the scale to practical use and to investigate its predictive value in a prospective evaluation.
'Advise yes, dictate no'. Patients' views on health promotion in the consultation.
Interviews with 130 mothers of lower social class provided the basis for studying their views on the desirability of general practitioner intervention in their lifestyle habits; the study used both quantitative (questionnaire) and qualitative (interview) techniques. The majority of women were in favour of counselling on specific topics by the general practitioner but the qualitative data also revealed that most respondents expected the issues to be relevant to their presenting problem. Moreover they were keen to assert their right to accept or reject the advice given. The same picture was obtained whether specific or general approaches were used. The results highlight the need for qualitative methods to amplify and clarify the results of quantitative techniques when views or attitudes are being explored. The practical implications of the conclusions touch on both the ethical and clinical dimensions of health promotion.
Treatment of peptic ulcer in general practice and in hospital: a comparison of omeprazole and cimetidine.
The aim of this study was to compare duodenal ulcer healing and symptom relief after two and four weeks treatment with omeprazole or cimetidine in groups of patients treated in general practice and as hospital out-patients. It was a randomised, double-blind, parallel group study with stratification for trial centre (hospital or GP). Endoscopy was performed at entry, after two weeks and, if unhealed at two weeks, after four weeks. All endoscopies were carried out in hospitals. In all, 189 patients were randomised (98 omeprazole, 91 cimetidine), 79 (42 per cent) of which by GPs, to either omeprazole 20 mg om (n = 41) or cimetidine 800 mg nocte (n = 38) for two to four weeks. After two weeks, ulcer healing occurred in 56 per cent (omeprazole) and 29 per cent (cimetidine) (p less than 0.05) of patients treated by GPs, and 67 per cent (omeprazole) and 36 per cent (cimetidine) (p less than 0.005) of those treated as hospital out-patients. Similar differences in healing rates were seen after four weeks. Omeprazole produces faster duodenal ulcer healing than cimetidine whether patients are treated as hospital out-patients or by GPs.
Management of asthma in the community.
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Desktop laboratory technology in general practice.
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Opportunistic health promotion: quantity or quality?
A cohort of 130 working class mothers has been studied in depth over five years to quantify the extent of recording and counselling of lifestyle problems by general practitioners and their staff. Clinical records and mothers' personal accounts at two home interviews five years apart provide the data for this work. Fifty-nine per cent of women had one or more aspects of lifestyle recorded in their records, the commonest being smoking habits. Despite this evidence for good coverage of smokers in the population, alcohol and exercise problems were under-recorded. Clinical records only included details of advice given and follow-up plans for lifestyle problems in 40% of patients' records yet the women themselves remembered advice being given in 48% of cases. An analysis of the womens' accounts in conjunction with the clinical records revealed that over three quarters of those receiving advice remembered it several years later. The primary care team was most likely to target advice and plans on women who were heavy smokers and very obese. This study shows that clinical records underestimate the amount of lifestyle counselling which is conducted in general practice and that a surprising number of working class women remember and act on the advice from their doctors. The implications for clinical recording of lifestyle factors are discussed.
Fragmentation and external control or discipline and internal rigour?
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The Open University pack on coronary heart disease: reactions of Welsh general practitioners.
The introduction of the new Open University distance learning pack on coronary heart disease to a selected group of Welsh general practitioners has been evaluated. The most commonly perceived disadvantages were the amount of time required to study the pack, the cost of buying it and the work involved in implementing its study in a practice by the whole primary-care team. Despite a relatively high level of awareness among the group, only 17% declared a positive intention to introduce the pack and another 17% thought they 'probably' would. Contact with primary care facilitators and informal feedback from colleagues appeared to distinguish those general practitioners who were motivated to try innovative postgraduate learning methods in their practices from the rest of the sample. The implications of trying to disseminate novel kinds of teaching material to general practitioners are considered.
Community nursing on the planning board again?
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Development of a measure of potential health behaviour: a salience of lifestyle index.
The development of a salience of lifestyle index to measure potential health behaviour is described with its validation, including the relationship between the new index and various measures of preventive health behaviour. The complex cascade of antecedents which contribute to a decision to make or not make a specific lifestyle choice is summarised to clarify the contribution of the salience of lifestyle index to pure research and evaluative studies.
Health promotion and the human response to loss: clinical implications of a decade of primary health care research.
Ten years ago an academic group was established in Cardiff to determine why the public make life-style choices which are known to have an adverse impact on health and also to develop methods of measurement which describe trends in positive health motivation (salience) in the community. Three stages of this research are described in this paper and the results reveal a complex and fascinating set of human beliefs, attitudes and behaviours. Concern for health was not a consistent human characteristic and there was little evidence for the existence of a general preventive orientation in the cohorts studied. Discrepancies between expressed health beliefs/attitudes and behaviours are more explicable when the reality of ambiguity and paradox is recognized in human responses. Human responses to loss (grief) may have similarities to the respondents' experiences when facing a possible change of life-style for health reasons. The practical implications for primary care professionals are discussed.
Research in general practice: a rapidly changing scene.
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Choice or chance: further evidence on ideas of illness and responsibility for health.
A study of 204 Welsh mothers using well validated research methods has demonstrated that better understanding of the antecedents to health behaviours contributes to a reorientation of stereotyped ideas about working class health beliefs and behaviour. Fatalism and an orientation to life-style choices for health are not necessarily contradictory concepts and this has important implications for those who are involved in education for health. The development of a Salience of Lifestyle Index (SLI) is described and studied in relation to concepts of blame for illness, education, house tenure, religious commitment, employment, health behaviours and social background.
Preventive procedures and practices among working class women: new data and fresh insights.
Using a sample of lower working class mothers from South Wales, U.K. data is presented on the extent to which procedures, (behaviours which involve health professionals and services) and practices (behaviours which involve the individuals in day to day lifestyle choices) are interrelated and likely to be practised by the same people. The socio-demographic variables associated with each category separately and with the whole range of preventive behaviour are also described. The British data is considered in the light of current research on preventive health behaviour (PHB) which has relied heavily for both empirical data and theoretical insight on studies conducted in U.S.A. No evidence is found to support the proposition that PHB is undimensional nor on the other hand is there convincing support for the existence of hypothesized independent dimensions. It is argued that the failure of present theory to predict more than a comparatively small part of the variance in PHB has positive implications for researchers and health educators alike.
Food-allergic asthma in general practice.
A survey was undertaken to assess the importance of food allergy in asthma. Seventy-two asthmatics aged 15-60 years were identified in a general practice and compared with 72 controls matched for age and sex. A diagnostic procedure involving dietary elimination and challenge was carried out on those who thought food exacerbated their symptoms, together with those with concurrent eczema, positive skin tests to food or positive food IgE-RAST. The asthmatics more frequently had positive skin tests of IgE-RAST to food than the controls, but these tests proved to be rather non-specific in identifying provoking foods. One patient was found to be allergic to wheat and his clinical condition improved when wheat was removed from his diet. Two patients seemed to respond to other foodstuffs, but the effects were small, the foods (honey and peppermint) unimportant, and the patients' symptoms appeared to be largely due to other factors. Most cases of alleged food-induced asthma could not be confirmed by challenge testing. This survey suggests that some degree of provocation by food (excluding drink) affects at least 4 per cent of adult asthmatics, although in some of these patients it plays an unimportant part in the disease.