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Biomedical subjects

R Carr-Hill

Publications and source records attributed to R Carr-Hill.

18 recordsLinked to original sources
PubMed1993

Consumption and harm: drinking patterns of the Irish, the English and the Irish in England.

There has been controversy over the relationship between alcohol consumption and related problems amongst the Irish in England. Irish migrants have high Standardised Mortality Ratios for chronic liver disease and cirrhosis and high hospital admission rates for alcohol-related diagnoses in England. Yet it has been considered that people from the Republic of Ireland, whether living in Ireland (Conniffe et al., 1990) or in England (Pearson et al., 1991), actually drink less than the English. This paper reviews the evidence. In recent years Irish per capita volume alcohol consumption has been comparable to that of the U.K., although the distribution of consumption differs. Women in Ireland are less likely to drink than women in England and Wales, while men in Ireland are more likely to drink at high-risk levels than men in England and Wales: their average weekly consumption levels are closer to those of high-consuming men in Yorkshire and Humberside, who also drink more than the U.K. national average. Men in Ireland also appear to be more likely to experience drinking problems than their counterparts in England and Wales, although this may be related to factors other than the total amount of alcohol consumed. Although a previous study of General Household Survey data indicated low-risk alcohol consumption levels for people from the Irish Republic living in Britain, a reanalysis of these data adjusting for age and gender shows drinking rates that are very high.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

Assessing the outcomes of nursing care.

There are many dimensions to outcome measurement for patient care and this study focuses on one aspect of outcome, namely that which is most concerned with the immediate effects of nursing care. Traditionally, outcome studies have been almost exclusively concerned with measuring the clinical outcomes of care with very little attempt being made to assess the effect of the nurses' contributions to that care. One of this study's purposes has been to redress this imbalance. As part of a research project on skill mix and the effectiveness of nursing care, a number of patient-focused standards related to the outcome of nursing care were designed. These were tested, in a case study situation, on 15 wards at seven acute hospitals. Initial testing indicates that these outcome measures show promise as a valid and reliable evaluation instrument with the utility for easy application in the clinical setting. They are being presented as a possible way forward to assessing the outcomes of nursing care.

Humans↗
PubMed1992

Rationality and the use of formulae in the allocation of resources to health care.

The paper describes how the apparent move towards rationality in allocating resources in the National Health Service using statistically based formulae is illusory. This is not just a technical problem of poor application of statistical techniques. The basic problem is to find a combination of factors reflecting dimensions of need and then appropriate weights with which to combine them within the context of the guiding principles of equity and efficiency. The paper explains how there has been little consistency in measuring need and how statistical methods have often masked the lack of appropriate data and models. Alternative approaches to measuring need within a policy context are discussed and a research agenda is outlined which, rather than concentrating on evermore complex statistical techniques, focuses on the necessity for more validly operationalizing 'needs' and their resource implications.

Health Resources↗
PubMed1991

Area variations in health outcomes: artefact or ecology.

It is a long-standing belief that the size of the difference between the poor (lower social groups) and the rich (higher social groups) in health outcomes will vary according to the characteristics of the area. However typical approaches to analyses of this kind of question violate standard statistical assumption. The basic problem is how to estimate the size of a 'ward effect' (the disadvantage of living in a 'poor' ward over and above effects associated with individual or household circumstances). This is complicated by the hypothesized existence of intra-ward correlated errors; the only way to avoid this bias is to explicitly model the different variance components using multi-level modelling techniques. The purpose of this paper is to illustrate this technique. Analysis using several of the health outcomes in the Health and Lifestyle Survey data, suggests that the ward effect is quite substantial, and remains after 'controlling for' age, gender and several other socio-demographic variables. This 'ward effect' appears to be best represented by the proportions without access to a car and the preponderance of working class members (RGSC IV and V) in the population. Whilst the verdict on the original hypothesis remains 'not proven', the hypothesis has been shown to be more complex than its simplistic statement suggests. The analyses have shown how to unpack these complexities and, more generally, have illustrated the power of the multi-level modelling technique.

Cluster Analysis↗
PubMed1990

The measurement of inequities in health: lessons from the British experience.

There has been an acrimonious debate about trends in inequality in health in the U.K. over the last couple of years. Whilst the acrimony is highly specific to the U.K. context, the terms of the debate contain general lessons for others who would venture into the same territory. This paper has focused on problems with using occupational classifications, with using groups of different size, with assessing trends in inequalities in death, with the measurement tool employed, with comparing patterns of ill-health and with the framework of explanation. The U.K. debate provides a good example of the first problem. Much of the debate has had to rely on the classification of occupation at the time of death by the Registrar General's Department. The scheme used was devised in 1911 and has persisted despite the massive changes in occupational structure since then. The groups now contain different occupational titles, and it is not at all clear what is being referred to by the RG scheme. Moreover, the balance of the RG groups has shifted dramatically. Any scheme applied regularly and routinely to mortality statistics over time will have these problems--it is not surprising that it is very difficult to interpret patterns of class death rates. The argument over trends in the U.K. has sometimes focused exclusively on the measurement tool--the standardized mortality ratios. Various alternatives have been proposed, in particular the Gini coefficient which clearly answers a different, possibly rather uninteresting, question. The correct way of comparing 'top' and 'bottom' is to devise a method which produces a group of constant size in the different communities or at different times. The focus on death rather than survivorship is queried as is the usual restriction to comparing rates of early death. Possibilities of comparing patterns of ill-health are examined in the fifth section. Whilst routine health care data or survey morbidity data are invaluable, it seems highly unlikely that they can be compared between communities or over time. The alternative is to develop a series of 'risk' indicators and these are discussed in Section 5.3. The examination of patterns of inequalities in death and ill-health highlights the complexity of discussing aetiology. We consider the balance between long-term and short-term effects and the possible role of (ill)-health on the social mobility process, and problems of directly relating low income to poor health.

Cause of Death↗
PubMed1987

Is birth weight determined genetically?

Birthweight correlations were analysed among 505 intergenerational pairs of first births to women aged 18-25 identified from a large obstetric data bank. After standardisation for fetal sex, maternal height, gestational age, and proteinuric pre-eclampsia residual correlations of between 0.1402 and 0.1725 were found, suggesting only a small genetic effect. It is concluded that genetic factors play only a small part in determining birth weight.

Adolescent↗
PubMed1987

The Nottingham health profile: a useful tool for epidemiologists?

The Nottingham health profile has been portrayed as a multipurpose measure of health status, capable of being used in population surveys and in evaluation of medical interventions. This paper examines basic operating characteristics of the profile, using data collected in a large survey of the community. Examination of the response pattern suggests that the NHP is not effective in discriminating health statuses as the modal response is zero. If it is to be used as a screening tool then there are considerable redundancies so that two or three items are sufficient; and for a diagnostic purpose, the existence of substantial covariation between items makes interpretation difficult. There is a need for an instrument fulfilling one or all of these purposes, but we need to know the operating characteristics of any instrument in detail before applying it. These results demonstrate that the methodological base of the NHP has yet to be established.

Epidemiologic Methods↗
PubMed1985

Pre-eclampsia in second pregnancy.

A total population of pregnant women from Aberdeen City District 1967-1978 has been studied. There were 29 851 pregnancies and 6637 women had a first recorded pregnancy between 1967 and 1978 and had two or more pregnancy events. As expected the incidence of pre-eclampsia in a second pregnancy was less than that in a first pregnancy, but it was dependent on the outcome of the first pregnancy. If the first pregnancy was complicated by proteinuric pre-eclampsia than the incidence of the condition in the second pregnancy was similar to that in a first pregnancy, but women who were normotensive in the first pregnancy had a reduced incidence of the condition in the second pregnancy. The incidence of proteinuric pre-eclampsia after early abortion (less than 13 weeks), either spontaneous or induced was similar to the population incidence in a first pregnancy, but after a late spontaneous abortion the risk of proteinuric pre-eclampsia was significantly reduced. Change of civil status of the offspring from first to second pregnancy did not affect the incidence of pre-eclampsia in a second pregnancy. There was an effect of birthweight in that women who had proteinuric pre-eclampsia in conjunction with a low-birthweight baby (less than 2500 g) in their first pregnancy had double the incidence of proteinuric pre-eclampsia in their second pregnancy. Only a pregnancy of 37 weeks or more is likely to offer protection or 'immunity' to pre-eclampsia in a second pregnancy and even then the effect is moderated by the development of pre-eclampsia in the first pregnancy.

Abortion, Spontaneous↗
PubMed1985

Concomitant and repeated happenings of complications of the third stage of labour.

Complications of the third stage of vaginal delivery have been studied among 36 312 women in Aberdeen between 1967 and 1981. There was no change in the incidence of retained placenta (RP), but there was a secular increase in postpartum haemorrhage (PPH). Postpartum haemorrhage was three times more common when there was a retained placenta. PPH was commoner in primiparae and after induced labour. The main focus of this paper is on the analysis of the risks of repetition among 6615 women with two or three live births between 1967 and 1980. A history of PPH and/or RP increased the relative risks of PPH and/or RP in a subsequent birth by between two and four times compared with women without such a history. The risk of repetition was increased if the subsequent birth was induced, or if there was an intervening abortion. Nevertheless, only a minority of the multiparae who experienced a third stage complication had a previous history of such a complication.

Abortion, Spontaneous↗
PubMed1983

Pre-eclampsia in a second pregnancy.

The incidence of pre-eclampsia in a second pregnancy has been studied in 6,637 women for Aberdeen City whose pregnancies occurred between 1969 and 1978. The rate of pre-eclampsia in second pregnancy is less than in first pregnancy, but this is altered by the outcome of the first pregnancy with reference to length of gestation, occurrence of pre-eclampsia and abortion.

Abortion, Induced↗
PubMed1982

Impact of sex ratio on onset and management of labour.

In a study of 52,266 live singleton deliveries in a total population male babies were delivered at earlier gestations than female. This difference was not due to induction or elective caesarean section. Female babies were more likely to present and be delivered by the breech. When the presentation was cephalic, male babies were much more likely to be delivered by forceps or caesarean section and female babies to deliver spontaneously.

Birth Weight↗
PubMed1980

Social indicators: for individual well-being or social control?

This article is concerned with the way that social statistics reflect particular views of the world, and focuses on the specific case of the Organization for Economic Cooperation and Development's program to develop a set of social indicators. Some illustrations of previous attempts to collect social indicators are given, but the bulk of the article discusses the series of contradictions which regulate the generation and use of statistics by governments, the principal one being between measures which play the ideological role of displaying economic and social "progress" and measures which are of direct use in social planning. This is discussed both for social indicators in general and for social concerns linked to the measurement of health. The article ends with an attempt to evaluate the future of the OECD program within the development of modern capitalism.

Government↗