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Biomedical subjects

R J Madeley

Publications and source records attributed to R J Madeley.

At least 37 records · Page 2Linked to original sources
PubMed1989

Postneonatal mortality in the Nottingham Health District 1985-1988.

Studies carried out in 1978 and 1981 found postneonatal mortality to be associated with poor environmental conditions. Since then, many changes have occurred to the environment. This study was designed to discover which factors are now associated with a higher risk of postneonatal death. A retrospective case-control study was carried out using 107 cases and 422 controls matched only for date of birth, to look at the effect of area of residence, social class, mother's age, and sex, birthweight, legitimacy and number of siblings. Fifty-eight per cent of the deaths were due to the sudden infant death syndrome, making this the leading cause of death. Causes previously absent from the death certificates are now appearing, particularly prematurity related deaths which now account for almost 6 per cent. The deaths were found to occur more frequently at home, in the winter, and at a peak age of 2 to 4 months. As shown previously in Nottingham, the deaths were more likely to have been male (relative risk 2.03), illegitimate (2.91), and of low birthweight (28.8). Total mortality was significantly higher in babies of mothers aged 19 or less and in babies of manual workers. Surprisingly, babies born to unemployed parents were found to have a very low relative risk of death (0.26). Mortality is still higher in the city than the suburbs and in areas of deprivation. Although still a risk factor for SIDS, high parity of the mother was found to be non-significant for postneonatal mortality in total.(ABSTRACT TRUNCATED AT 250 WORDS)

England↗
PubMed1988

Evaluation of the Nottingham birth scoring system.

A case-control study of postneonatal deaths occurring in 1974-1976 in the City of Nottingham, England, revealed that most were attributable to respiratory infections and SIDS, and primarily occurred in wintertime, at home, in the less well-off parts of Nottingham. By means of a step-wise discriminant analysis, 9% of the infant population was identified as a high-risk group in whom 53% of postneonatal deaths could be expected to occur. From January 1, 1978, this group of infants was followed up more intensively by health visitors and general practitioners, who gave advice on the early recognition of respiratory symptoms. Although the postneonatal mortality rate fell from 6.5 per 1,000 live births in 1977 to 5.2 per 1,000 in 1983, it is not possible to show that the rate of improvement was any faster after the introduction of the system. The system was discontinued on March 31, 1985. Birth scoring systems are not recommended; instead, resources should be concentrated on general improvements in services and symptom recognition, and basic research into the causes of SIDS.

Child Health Services↗
PubMed1986

Prevention of postneonatal mortality.

Studies of postneonatal mortality in Nottingham between 1974 and 1977 showed a familiar pattern of high death rates in socially deprived parts of the city. A birth scoring system was devised, which identified at birth 9% of infants in whom 53% of postneonatal deaths could be expected to occur From 1 January 1978 this group was identified by midwives and followed up intensively by health visitors. The postneonatal mortality in the city of Nottingham fell from 8.7/1000 live births in 1974 to 3.6/1000 in 1981. It was not possible, however, to show that the rate of improvement after the introduction of the birth scoring system was greater than the trend present before its introduction. The causes of postneonatal death, and their geographical and seasonal distribution, were similar in 1978-81 and 1974-77, despite an absolute fall in numbers. By 1981 the important risk factors were either recorded on the birth notification or known to the health visitor in any case. Although nurse managers and most health visitors have found the scheme useful in other respects--for example, resource allocation--it was considered that these could be achieved without a formal scoring system. Therefore, the birth scoring system was stopped at the end of March 1985. Health visitors are still being encouraged to pay more attention to high risk cases as a part of normal clinical practice.

Birth Weight↗
PubMed1986

Research in epidemiology and community health in the medical curriculum: students' opinions of the Nottingham experience.

Medical students in Nottingham all complete an honours Bachelor of Medical Sciences course in one department including a research project. The honours programme in community health is described, with results from a survey of the 122 graduates since the medical school started. The 98 (80%) responses showed high levels of satisfaction and gain from the programme, the great majority regarding the course as valuable, enjoyable, and giving both research skills and skills in interpersonal relationships.

Attitude to Health↗
PubMed1985

Changing overall workload in neonatal units.

An epidemiological study was carried out in the current Nottingham health district to determine changes in both neonatal unit workload and in the infants requiring neonatal care during two study periods. All admissions for 1977 and again for the 12 months 1 April 1983 to 31 March 1984 were reviewed. Total numbers of admissions have shown roughly a 50% reduction because of a more rigorous admission policy locally. The admissions of infants of 33 weeks' gestation or less have shown a significant increase, while the overall survival of infants less than 33 weeks' gestation has improved.

Birth Weight↗
PubMed1984

Primary health care in practice: a study in Mozambique.

This study investigates the delivery of all aspects of Primary Health Care (PHC) in a case study of one urban health centre in Maputo, Mozambique. Within the context of overall social and economic change, Mozambique has given priority to primary health care as the driving force in its newly developed National Health Service. The urban and rural health centres are intended to be the principal vehicles for PHC delivery, and in this study one of Maputo's recently opened health centres was investigated by observing all clinic sessions, interviewing all health centre workers and collecting data from health centre records. It was found that a dichotomy exists between the tasks ascribed to the health centre in the PHC framework, and the feasibility of their execution given existing personnel and material resources. This derives in part from lack of involvement of PHC practitioners in the organisation and planning of PHC, plus resource allocation which remains in favour of secondary and tertiary rather than primary care. Prevention is accorded priority in PHC theory, yet investigation showed that the major demand on the health centre is for curative care. The quality of both curative and preventive care was evaluated and the need for training in specialist diagnostic skills, and a more socially-based understanding of the determinants of health status and risk emerged, respectively for the groups of workers in the two sectors. The level of contact between the curative and preventive sectors was investigated as was the integration of the health centre into the health service as a whole. The problems arising in these areas must be viewed in the context of the very recent development of a National Health Service in a country where, previously, curative care was available only in urban areas and virtually no preventive programmes existed. This study shows that significant steps are being taken to develop a comprehensive PHC programme in Maputo. More important still will be the extension of this level of care provision to the country as a whole.

Adolescent↗
PubMed1984

The uptake of preventive and curative child health services in Maputo, Mozambique.

This study seeks to analyse the uptake of preventive and curative child health services in three health centres in Maputo, Mozambique. Within the context of overall social and economic change, Mozambique has given priority to Primary Health Care as the driving force of its newly developed National Health Service, with a principal focus on maternal and child health. Three health centres were selected from areas of contrasting environmental quality. Data were collected from over 6000 women attending the curative and preventive child health services at these centres. It was found that the women using curative services had significantly higher child mortality rates, had lived less time in Maputo City and had children of lower weight status than their counterparts attending for preventive care. Additionally, levels of child mortality were found to increase as environmental quality decreased. It is argued that the lower users of preventive care are, as in the U.K., precisely those who appear to have an increased risk of mortality and morbidity. It is concluded that integration between the curative and preventive health services must be increased in order to overcome the user inertia which militates against the poorer population using the facilities for prevention to the best advantage. This would fit in both with national strategies (1) and WHO recommendations (2-4) in the field of primary health care.

Age Factors↗
PubMed1983

Antenatal care in Maputo, Mozambique.

Mozambique, within its plan for overall social and economic change, has given priority to primary health care with a principal focus on maternal and child health. In 1980 an antenatal control form was introduced into all Maputo's antenatal clinics to monitor pregnancies and to help direct specialist care to mothers at greatest risk--a strategy known by WHO as the "risk approach." In this study three health centres were selected from contrasting areas of the city. Almost 1000 completed antenatal forms were analysed to determine incidence of risk and to evaluate the implementation of this strategy. It was found that: (1) a considerable number of women at risk were identified, referred, and successfully monitored through their pregnancy. (2) Of those women at risk who were identified by the health centres, fewer than half were actually referred for specialist care. (3) Those women at greatest risk were not the highest users of the services, and many of them underused the services compared with those at lower risk. (4) The level of risk and child mortality varied with a measure of urban quality of the areas in which the centres were located.

Adolescent↗
PubMed1983

Preventive health care for mothers and children. A study in Mozambique.

This study seeks to evaluate the delivery of preventive mother and child health services in Maputo, Mozambique. Mozambique has given priority to primary health care in the development of its new National Health Service, with a principal focus on maternal and child health (MCH). Three health centres were selected, from areas of contrasting urban ecology. Prenatal and under-fives' clinics were observed at each health centre. It was found that at a technical level the preventive services were operating efficiently, with a coverage of over two-thirds of the target population. However, frequency of attendance at both clinics was much lower in the poorer areas of the city. Additionally, it was observed that women and children identified as having a high risk status were rarely given more care and support. Nurses and midwives, frequently adopted an attitude more punitive than supportive to those most at risk. Notwithstanding these shortcomings, it is clear that significant advances in preventive MCH care are being achieved in a country where 6 years previously the only available health services were curative, and confined to the better-off urban districts.

Child, Preschool↗
PubMed1980

The consequences of exposure to asbestos dust in a wartime gas-mask factory.

This further study of wartime gas-mask workers who were exposed to asbestos dust has shown that among those who worked with crocidolite there is a considerable excess of cases of mesothelioma, a more modest excess of bronchial carcinoma, but no excess of any other type of malignant disease. A dose-response relationship is established in the mesothelioma and bronchial carcinoma patients. It is not possible to base any conclusions on the limited data available for the small number of people exposed to chrysotile for a maximum period of five months. We believe that the identification and measurement of fibres in autoptic lung tissue from patients with accurately known occupational histories of asbestos dust exposure is useful, and a similar study on a population exclusively exposed to chrysotile would be of considerable interest.

Asbestos↗
PubMed1978

Doctors' attitudes to information systems: a survey of Derbyshire general practitioners.

This paper describes the results of a survey of all 365 general practitioners in Derbyshire. It deals in particular with their attitudes to information systems and the factors which affect them. The results show that there is much more interest in continuous data collection from primary care than is often supposed. This is particularly so among younger general practitioners. The survey thus describes the possible interest in information recording amongst a typical population of general practitioners.

Adult↗