Biomedical subjects
Publications and source records attributed to P Higgs.
Sacrocolpopexy is a surgical procedure that provides effective treatment for pelvic prolapse. The surgical technique and complications of laproscopic sacrocolpopexy are described. This review presents experience of MRI for postoperative assessment and illustrates normal and abnormal findings.
A growing literature demonstrates life course influences on health in early old age. The present paper is the first to examine whether similar processes also influence quality of life in early old age. The question is theorised in terms of structured dependency and third age, and the life course pathways by which people arrive at these destinations in later life. The issues are investigated in a unique data set that contains health and life course information on some 300 individuals mostly aged 65-75 years, enhanced in 2000 by postal survey data on quality of life. Several types of life course effect are identified at conventional levels of statistical significance. Long-term influences on quality of life, however, are less marked than those on health. Quality of life in early old age appears to be influenced primarily by current contextual factors such as material circumstances and serious health problems, with the influence of the life course limited mostly to its shaping of an individual's circumstances in later life. The implication for policy is that disadvantage during childhood and adulthood does not preclude good quality of life in early old age.
Quality of life is the subject of much research. However it lacks an agreed theoretical basis. In studies with older populations(ill) health has been used as a proxy measure for quality of life (QoL). We have developed a needs satisfaction measure of QoL in early old age. Our measure has four ontologically grounded domains: conal, autonomy, pleasure, and self-realization. The measure was piloted with focus groups, a self-completion pilot, and cognitive interview testing. This produced a 22-item scale that was included in a postal questionnaire and sent to 286 people aged 65-75 years.A 92% response rate was achieved. The scale was reduced to 19 items on the basis of statistical analysis. The domains have Cronbach's alphas between 0.6 and 0.8. Correlations between the four domains range from 0.4 to 0.7. A second order factor analysis revealed a single latent QoL factor. The scores for the 19-item scale are well distributed along the range although they exhibit a slight negative skew. Concurrent validity was assessed using the Life Satisfaction Index--wellbeing. A strong and positive association was found between the two scales (r= 0.6, p = 0.01). The CASP-19 appears to be a useful scale for measuring QoL in older people.
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OBJECTIVE: To investigate patterns of drug use and injection-related risk behaviours among young Indo-Chinese injecting drug users (IDUs). METHOD: Cross-sectional survey. A structured questionnaire was administered to 184 Indo-Chinese IDUs aged 15 to 24 in Sydney and Melbourne. Participants were recruited using snowball sampling techniques; measures included patterns of heroin and other drug use, injection-related risk behaviours, perceived susceptibility to HIV and HCV infection and access to services. RESULTS: Despite perceived high availability of sterile injecting equipment, 36% had ever shared a needle and syringe and 22% had done so in the preceding month. Lifetime sharing was significantly associated with duration of injecting, history of incarceration and residence in Sydney. Sharing of injecting paraphernalia other than needles and syringes was also common, with young women and Sydney residents significantly more likely to report sharing equipment in the preceding month. CONCLUSIONS: Young Indo-Chinese IDUs are at high risk of infection with hepatitis C and other blood-borne viruses. Results indicate an urgent need for culturally appropriate and sustainable risk reduction programs which specifically target this population. IMPLICATIONS: Health services must respond swiftly to implement effective blood-borne virus prevention programs for young Indo-Chinese IDUs. Failure to do so may sustain the current epidemic of hepatitis C among IDUs.
In much the same way that developments in genetics have opened up new areas of activity in health services, the 'new genetics' has also stimulated a renewal in approaches that try to explain the nature of health behaviours within the context of human biological development. Evolutionary psychology, as an umbrella term for these views, stresses the importance of the brain as an intermediary between genes and individual behaviour. From such a perspective, social context is less important than an understanding of why certain behaviours are 'chosen' by the evolutionary process and how they are predicated on reproductive success. Health policy is a key area where these ideas are likely to become important given evolutionary psychology's focus on the interplay between physiological and psychological factors in determining health behaviours. Health research provides a fertile environment because it is already seeking the hidden biological pathways connecting social status with specific diseases. The challenge represented by evolutionary psychology needs to be taken seriously because of the way in which such ideas mesh with the individualistic basis of much health promotion and health policy. In particular, it poses a challenge when it purports to explain how inequalities in health are not necessarily the result of the unequal distribution of income in society but are natural phenomena. It is also important to engage with such ideas because they increasingly seem likely to occupy the empty ideological space created by the disappearance of politics in policy and as such may have a greater impact than would otherwise be the case.
This paper evaluates four well established sociological theories of ageing using qualitative data from the British Whitehall II study. We attempt to apply the theories to contemporary retirement and through each theory examine the issue of health in retirement. The effect of lowered income in retirement is discussed in relation to Townsend's theory of structured dependency. Change in participant's health following retirement is examined in respect of the theory of disengagement by Cumming and Henry, adjustment to retirement in relation to Laslett's theory of the third age. Parson's role theory is used to examine how social interactions and relationships change for people who have recently retired. We discuss the need for a multifaceted theory of ageing which can accommodate the continually changing experience and age of retirement. We analysed interviews conducted with 25 male and female civil servants aged between 55 and 63 years, from different grades who had been retired for less than 2 years.
Endometriomas are rare in pregnancy, may not be large, may be difficult to diagnose definitively and although benign, may cause significant complications at any stage during gestation. They remain a management dilemma.
OBJECTIVE: To assess the value of performing routine pulmonary function tests by flow-loop spirometry in young adolescents with asthma. DESIGN: A prospective clinical study comparing clinical assessment and patients' self-reporting of asthma severity with the results of pulmonary function tests. SETTING: General practice in a small rural community of about 30,000 people. PATIENTS: Young adolescents with asthma, aged 10-15 years, were enrolled in the study over a two-year period from July 1993 to June 1995 when they presented for either elective, interval assessments or with an acute exacerbation of asthma. MAIN OUTCOME MEASURES: Discrepancy between (i) the doctor's and the patient's perception of asthma control (six scale measures) and the consequent management plans, and (ii) the results of pulmonary function tests that indicated less than adequate airway function (i.e., forced expiratory volume in one second as a percentage of predicted vital capacity for height and sex [FEV1%] less than 65% or average flow rate over the middle 50% of forced vital capacity as a percentage of predicted normal value [FEF25%-75%] less than 65%). RESULTS: Twenty-seven adolescents with asthma were assessed on a total of 37 occasions. The results of pulmonary function tests did not correlate with asthma symptoms and treatment in 11 of the 37 assessments (30%; 95% confidence interval [CI], 16%-47%). The 11 assessments were performed on eight patients. CONCLUSIONS: This small community-based study of adolescents with asthma supports the view that pulmonary function testing by flow-loop spirometry should be part of the routine assessment of acute and chronic asthmatics. Further study in a larger community is needed to clarify the frequency of over- and underestimation of asthma severity in this difficult age group.
All issues of The Journal of Hand Surgery (American) from volume 1, number 1 through volume 19, number 6, were reviewed to identify studies that might qualify as prospective, comparative clinical trials. Prospective studies that compared two or more clinical treatments were labeled as either randomized controlled trials (RCT) if they included some form of random assignment or controlled clinical trials (CCT) if they did not. A total of 25 CCT and 8 RCT were identified among the 3,107 articles, letters, and abstracts that were reviewed. The results will be used to update the Medline Database, to make online identification of RCTs and CCTs easier.
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A series of subjective and objective measures were chosen to determine impairment of upper extremity function in 157 workers performing repetitive tasks. Workers were asked to respond to questions regarding their perception of the presence or absence of numbness, pain, weakness, or swelling in their upper extremities. Objective tests consisted of the measurement of grip strength, pinch strength, Semmes-Weinstein monofilament sensory responses, vibrometer responses, neurometer measurement, and the presence or absence of Tinel's or Phalen's signs. These measures were considered collectively to estimate the overall levels of impairment of each individual. Overall findings show that 55 percent of workers examined had impairment scores of 2 or more and 75 percent had scores of 1 or more. Significant differences were found in impairment ratings between job types. Those jobs requiring the highest repetition with the least rest per cycle had the highest impairment ratings. Workers that rotated jobs had impairment scores significantly less (p less than 0.005) than the average of workers performing single-task jobs. We conclude that cumulative trauma disorders are more prevalent than originally believed and that the disorder is best examined from an overall functional impairment perspective.
This paper describes a survey which focuses on the patients in National Health Service long-term care beds. It examines the dependency levels and mental impairment of geriatric patients in 15 Departments of Geriatric Medicine, and determines the extent and distribution of patient dependency, including the number of independent patients. The findings support the view that there is a need for National Health Service long-term care beds.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.