PubMed Health⌕ Search

Biomedical subjects

P I Frank

Publications and source records attributed to P I Frank.

12 recordsLinked to original sources
PubMed2005

Prevalence of respiratory symptoms in under 5s: 1993 to 2001.

AIM: To describe changes in the prevalence of respiratory symptoms in 1-4 year olds in two general practice populations observed on four occasions over an eight year period. METHODS: In 1993, 1995, 1999, and 2001, questionnaires were posted to the parents of patients aged 15 years or younger and registered with either of two general practices. Only children aged 1-4 years at time of questionnaire completion were included in this study. For each survey, the prevalence of five key variables was determined. RESULTS: The response rates for all children in the four surveys were 72.8%, 70.6%, 65.0%, and 60.7% respectively. When respondents aged 1-4 years old were stratified into one-year age bands, there was a decrease in the prevalence of symptoms over the study period. This was statistically significant for wheeze and night cough in 2 year olds and for night cough in 4 year olds. Repeated antibiotic prescriptions decreased significantly for 2 and 3 year olds. There were no changes in the prevalence of hay fever or eczema and family history of asthma. CONCLUSIONS: The downward trend in symptom prevalence might represent a real decrease in symptoms or improvements in treatment. In the absence of changes in the prevalence of hay fever and family history of asthma, the downward trend in symptom prevalence may suggest changes in the prevalence of conditions other than asthma.

Age Distribution↗
PubMed2004

Trends in smoking habits: a longitudinal population study.

BACKGROUND: In 1998, the UK government published a White Paper in which it set long-term targets for reducing smoking in the population. This longitudinal study aimed to examine whether progress has been made in achieving these in two adult general practice populations over an 8-year period. METHODS: Postal respiratory questionnaires, based on the European Community Respiratory Health Questionnaire, were sent to all patients registered with two practices in North West England on four occasions between 1993 and 2001. Two analyses were carried out. The first (smaller cohort) included only those subjects answering the question concerning current smoking on all four occasions, the second (larger cohort) those answering at least twice. RESULTS: The smaller cohort included 2403 subjects (19.6% of all respondents). Almost one-quarter reported in all four surveys that they smoked, the highest proportion being in those aged 35-44 years. The proportion of smokers decreased from 34.2% (1993) to 30.3% (2001) (P < 0.001 for trend) and the prevalence of heavy smokers fell from 15.9 to 13.3% (P < 0.001 for trend) over the same period. There were, however, no reductions in those aged <45 years in 1993. These changes were confirmed in the larger cohort which included 7274 subjects (59.3% of respondents). CONCLUSIONS: If smoking-related disease is to be reduced, it is important that adults are targeted for smoking prevention and cessation before they reach middle age. Only when such initiatives show success will smoking prevention among their children become a practical proposition.

Adolescent↗
PubMed2001

Using a neural network to screen a population for asthma.

PURPOSE: To use a neural network to rank a population according to individual likelihood of asthma based on their responses to a respiratory questionnaire. METHODS: A final diagnosis of asthma can be made only after full clinical assessment but limited resources make it impossible to offer this to complete populations as part of a screening programme. Prioritisation is required so that review can be offered most promptly to those most in need. A stratified random sample of 180 from 6825 respondents to a community survey underwent clinical review. They were categorised according to likelihood of asthma by three independent experts whose opinions were combined into a single probability label for each patient. A neural network was trained to relate questionnaire responses to probability labels. The trained network was applied to the whole community to produce a ranking order based on likelihood of asthma. A screening threshold could then be set to correspond to available resources, and patients above this level with no recorded evidence of asthma diagnosis could be assessed clinically. Using the known probability labels from the training set, it was possible to derive the expected proportion of true asthmatics in any set of patients. RESULTS: If the screening threshold had been set to capture the top 10% of the ranked population (n = 683), then 239 patients above this threshold had no evidence of diagnosis and would need assessment. Of these, it would be expected that 74% would have the diagnosis confirmed. CONCLUSIONS: This approach allows prioritisation of a population where resources for diagnostic examination are limited.

Adolescent↗
PubMed2001

Respiratory illness and healthcare utilization in children: the primary and secondary care interface.

The aim of the present study was to quantify the healthcare utilization of a child population according to level of respiratory illness. A stratified random sample of 713 children was selected from respondents to a postal respiratory questionnaire, carried out in two general practice populations in 1993. Children were stratified into four groups according to the number of positive responses to five key questions. These groups were used as indicators of likelihood of asthma diagnosis. A search was made of these childrens' practice records covering a 2-yr period, to include both primary and secondary healthcare. There was a significant increase across positive response groups in the proportion of children having primary and secondary care based consultations, particularly for respiratory conditions (p = 0.001). There was also a significant increase in prescribing. Of those children considered to be "likely asthmatics" from their questionnaire responses, 8.1% (n = 31) did not receive any primary or secondary care for a respiratory problem over the 2-yr period. As the likelihood of respiratory illness increased in this population, more demand was made upon resources for the treatment of respiratory illness. Quantification of this demand enables evidence based resource allocation decisions to be made. This method of quantification could be applied in other populations.

Asthma↗
PubMed2001

The use of a screening questionnaire to identify children with likely asthma.

BACKGROUND: The theory that airway remodeling and possible fixed asthma may result from failure to treat asthma airway inflammation highlights the importance of the early identification of patients with likely asthma. AIM: To identify children with likely asthma whose condition is unknown to the medical services. STUDY: Postal questionnaire survey. SETTING: Children in two general practice populations in 1999. METHOD: Parents completed the postal questionnaire surveys. Two validated scoring systems were used to identify children with 'likely asthma': first, three or more positive responses to five key questions; second, three or more positive responses to the same five questions and one more severe symptom (e.g. exercise-induced wheeze). Questionnaire responses were linked to practice records to determine those with a recorded diagnosis of asthma (ever) or of inhaled medication (past 12 months). RESULTS: Using the first scoring system, 22.5% of children were identified as having likely asthma; more than one-third of these (35.1%) had no corroborative evidence recorded in the practice records. With the second system, 15.5% had likely asthma, a quarter of whom had no corroborative evidence. Depending on the scoring system chosen, between 3.5% and 8% of children in these practices had likely asthma but no corroborative evidence in their records. CONCLUSIONS: Children identified using either of these scoring systems would require full clinical assessment to determine their need for medical intervention. These findings have implications for the allocation of health care resources.

Adolescent↗
PubMed1999

Assessment of a simple scoring system applied to a screening questionnaire of asthma in children aged 5-15 yrs.

The aim of the present study was to validate a simple scoring system using a parent-completed screening questionnaire to identify children aged 5-15 yrs who may have asthma. A stratified random sample of 157 children of 1,808 whose parents had answered a postal respiratory questionnaire underwent detailed clinical evaluation. The results were reviewed by three independent paediatricians whose opinions were combined to reach, for each child, decisions regarding three standards: 1) "possible asthma" defined as >50% likelihood of having asthma; 2) "possible asthma" defined as meriting a clinical trial of asthma medication; and 3) "probable asthma" defined as >90% likelihood of having asthma. The combined decisions were compared to three sets of questionnaire scores, in order to determine the positive predictive value, sensitivity and specificity of each set in identifying children with probable/possible asthma. The three sets of chosen questionnaire scores all had positive predictive values of 79-96% for predicting possible asthma, using either the combined expert opinion ">50% likelihood of asthma" or that of "warrants a trial of treatment" as the definition. This suggests that a low proportion of false positives would be obtained were this scoring system to be used for a screening programme. The combined decision >90% chance of asthma could be used as a means of estimating prevalence of asthma in the survey. When used for this, the prevalence of asthma in the surveyed population was 18.8% (95% confidence interval 13.1-26.3). In conclusion, the present scoring system, based on a simple respiratory questionnaire, provides a valid method of identifying children likely to have asthma, and who, if unknown to the medical services, would benefit from clinical review.

Adolescent↗
PubMed1998

Relationship between exhaled nitric oxide and childhood asthma.

The purpose of the study was to determine if exhaled nitric oxide levels in children varied according to their asthmatic and atopic status. Exhaled nitric oxide was measured in a sample of 93 children attending the North West Lung Centre, Manchester, United Kingdom, for the clinical evaluation of a respiratory questionnaire being developed as a screening tool in general practice. The clinical assessment included full lung function, skin prick testing, and exercise challenge. Children were said to be asthmatic either by consensus decision of three independent consultant pediatricians, who reviewed all the clinical results except the nitric oxide measurements, or by positive exercise test. Atopic asthmatic children had higher geometric mean exhaled nitric oxide levels (consensus decision, 12.5 ppb [parts per billion] 95% CI, 8.3 to 18. 8; positive exercise test, 12.2 ppb 95% CI, 7.6 to 19.7) than did nonatopic asthmatic children (3.2 ppb 95% CI, 2.3 to 4.6; 3.2 ppb 95% CI, 2.0 to 5.0), atopic nonasthmatic children (3.8 ppb 95% CI, 2. 7 to 5.5; 5.7 ppb 95% CI, 4.1 to 8.0), or nonatopic nonasthmatic children (3.4 ppb 95% CI, 2.8 to 4.1; 3.5 ppb 95% CI, 3.0 to 4.1). Thus, exhaled nitric oxide was raised in atopic asthmatics but not in nonatopic asthmatics, and these nonatopic asthmatics had levels of exhaled nitric oxide similar to those of the nonasthmatics whether atopic or not.

Adolescent↗
PubMed1991

The effect of induced abortion on subsequent pregnancy outcome.

OBJECTIVE: To investigate the effect of induced abortion on the outcome of the next pregnancy. DESIGN: Long-term prospective controlled cohort study. SETTING: Joint Royal College of General Practitioners/Royal College of Obstetricians and Gynaecologists study based in general practice in England, Scotland and Wales. SUBJECTS: 1311 women whose recruitment pregnancy had ended in induced abortion (the abortion group) and 2131 women whose recruitment pregnancy had a natural conclusion (the non-abortion group). MAIN OUTCOME MEASURES: Non-viable outcome (spontaneous or missed miscarriage, ectopic pregnancy or stillbirth), birthweight, length of gestation. RESULTS: Induced abortion was not materially associated with any of the three measures of adverse outcome. Compared with the non-abortion group the relative risk of a non-viable outcome in the abortion group was 1.01 (95% CI 0.81 to 1.27). In the abortion group birthweight was an average 23 g lighter (95% CI -76 g to + 30 g) and length of gestation an average 0.9 days shorter (95% CI -2.2 days to + 0.4 days) than in the non-abortion group. Women who had their abortions in NHS premises had an increased risk of a non-viable outcome (RR 2.55, 95% CI 1.31 to 4.94) and had babies with significantly lower mean birthweight (-119 g, 95% CI -233 g to +5 g) compared with those who obtained their operations in the private sector. Women whose abortion had been carried out by a consultant had the lowest risk of non-viable outcome. Although these differences remained after adjustment for a number of important variables, it is possible that factors not measured in the present study, such as economic status and occupation, played a contributory role. CONCLUSION: Overall, induced abortion was not associated with any important effect on the three measures of adverse outcome in the subsequent pregnancy.

Abortion, Induced↗
PubMed1987

Pregnancy following induced abortion: maternal morbidity, congenital abnormalities and neonatal death. Royal College of General Practitioners/Royal College of Obstetricians and Gynaecologists Joint Study.

In a prospective cohort study of the long-term sequelae of induced abortion, a comparison is made between a group of 6418 women who had an induced abortion (cases) and a control group of 8059 women recruited with an unplanned pregnancy which was not terminated with an induced abortion (controls). The present paper reports on 729 cases and 1754 controls who had a post-recruitment pregnancy. In general, prior induced abortion had no material effect on the rate of pregnancy-related morbidity, nor on the rate of congenital abnormalities and neonatal death in the offspring. There was, however, a significant difference in two specific conditions. In the post-index pregnancy in the cases there was an increased relative risk (RR 2.26) of the occurrence of urinary tract infection and a decreased risk (RR 0.25) of pregnancy-related anaemia.

Abortion, Induced↗
PubMed1985

Outcome of pregnancy following induced abortion. Report from the joint study of the Royal College of General Practitioners and the Royal College of Obstetricians and Gynaecologists.

A total of 1590 general practitioners and 795 gynaecologists in England, Scotland and Wales are participating in a long-term, prospective study concerning the sequelae of induced abortion. In the present report a comparison is made between the outcome of the first post-index pregnancy in 745 women whose index pregnancy ended in an induced abortion (cases) and that in 1339 women who had an unplanned index pregnancy but were not referred for induced abortion (controls). There were no statistically significant differences between cases and controls. The increased relative risk which was found amongst the induced abortion group of non-viable outcome, low birthweight and shortened gestation, could have arisen by chance. Further analysis of a larger number of pregnancies is required to permit confident interpretation of these observations. The present data provide no reason for alterations in the current management of induced abortion, or the subsequent pregnancy.

Abortion, Induced↗
PubMed1981

Characteristics of women recruited to a long-term study of the sequelae of induced abortion. Report from a joint RCGP/RCOG Study co-ordinated by the Royal College of General Practitioners' Manchester Research Unit.

One thousand, five hundred and nine general practitioners and 795 gynaecologists are co-operating in a large, long-term, controlled, prospective study of the sequelae of induced abortions. The ;case' (6,349 patients) and control (8,132 patients) groups are comparable, and the patients who had induced abortion are also comparable in age, marital status and parity with those in the national abortion statistics. The study should, therefore, give a sound basis for evaluating the long-term hazards of the operation.

Abortion, Induced↗