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Biomedical subjects

S Quine

Publications and source records attributed to S Quine.

At least 19 recordsLinked to original sources
PubMed2004

What constitutes success in preventive health care? A case study in assessing the benefits of hip protectors.

The economic success of preventive health programs is typically assessed by the net health-related utility gain or loss to society relative to the cost. Issues relating to the positive or negative utility associated with participating in a preventive health program are often ignored. However, it is likely that calls for informed consumer choice and respect for patient autonomy will provide an impetus to examine utility associated with the process and outcomes of preventive health programs. In this paper, we outline the nature of the ex ante and ex post perspective in evaluating benefits and the presence of process utility and the utility of gambling in individual's utility function for preventive health care. The implications of including process attributes and psychological states when assessing benefits to society are discussed in relation to an empirical study on the value of external hip protectors for the prevention of hip fractures. We demonstrate that wearing hip protectors and the psychological outcomes of being a participant in the program can have a significant impact on individual's assessment of the benefits. Furthermore, point of reference plays a crucial role in their valuation. Individuals who did not consent to participate in a trial of hip protectors valued all states significantly lower than those who did participate in the trial. We argue that the utility associated with adherence to the intervention is an important issue for preventive health policy. From the viewpoint of applied welfare economics, evaluation of preventive health programs should allow for both process and outcome utility when assessing benefits. In this context, success might be viewed as maximising the opportunity for individuals to make an informed choice.

Aged↗
PubMed2003

Health and access issues among Australian adolescents: a rural-urban comparison.

INTRODUCTION: Previous research has reported rural-urban differences in health concerns and access issues. However, very little of this has concerned young people, and what has been published has been mainly from countries other than Australia and may not generalise to Australian youth. The study described in this paper is a subset of a larger study on health concerns and access to healthcare for younger people (12-17 years) living in New South Wales (NSW), Australia. This paper reports findings on rural-urban similarities and differences. The specific study objective was to identify and describe rural-urban differences, especially those associated with structural disadvantage. METHOD: The reported findings form part of a larger state-wide cross-sectional study of access to healthcare among NSW adolescents. Adolescents were drawn from high schools in ten of the 17 Area Health Services in NSW. These Area Health Services were selected because they represent most aspects of rural-urban NSW with respect to population characteristics and health services. Eighty-one focus groups were conducted with adolescents (35 with boys and 46 with girls), of which 56 were conducted in urban, 22 in rural and 3 in regional areas. The focus groups were tape-recorded, transcribed and analysed using the computer software package NUD*IST 4. RESULTS: The analysis revealed certain health concerns that were common to both rural and urban adolescents: use of alcohol and illicit drugs, bullying, street safety, diet and body image, sexual health, stress and depression. However, certain concerns were mentioned more frequently in rural areas (eg depression), and two concerns were raised almost exclusively by rural youth (youth suicide and teenage pregnancy). There were also structural differences in service provision: adolescents in rural areas reported disadvantage in obtaining access to healthcare (limited number of providers and lengthy waiting times); having only a limited choice of providers (eg only one female doctor available), and cost (virtually no bulk billing--ie direct charge to Medicare with no patient co-payment). A lack of confidentiality as a barrier to seeking service access was raised by both rural and urban youth, but was a major concern in rural areas. No issues specific to urban areas were raised by urban youth. Male and female rural adolescents were more likely than urban adolescents to express concerns over limited educational, employment and recreational opportunities, which they believed contributed to their risk-taking behaviour. Gender differences were evident for mental health issues, with boys less able to talk with their peers or service providers about stress and depression than girls. These gender differences were evident among adolescents in both rural and urban areas, but the ethos of a self-reliant male who does not ask for help was more evident among rural boys. CONCLUSIONS: While Australian rural and urban youth shared many health concerns, rural-urban differences were striking in the almost exclusive reporting of youth suicide and teenage pregnancy by rural adolescents. The findings suggest that structural disadvantage in rural areas (limited educational, employment opportunities, and recreational facilities) impact adversely on health outcomes, particularly mental health outcomes, and contribute to risk-taking behaviour. Such disadvantages should be considered by health-service policy makers and providers to redress the imbalance. Gender differences were also evident and efforts to target the specific needs of Australian adolescent boys are warranted.

Journal Article↗
PubMed2003

Adherence with hip protectors: a proposal for standardised definitions.

Definitions of adherence, also termed compliance, with use of hip protectors have varied in published studies, making interpretation of results difficult. This paper proposes standard definitions of adherence with the use of hip protectors. Adherence is the wearing of hip protectors in accordance with the recommendations of the study protocol, and is measured as the amount of time hip protectors are worn. When reporting use of hip protectors in clinical trials investigators should indicate the specific definition of adherence used, explicitly state the recommendation that was made for use of hip protectors during the study, and describe the methods of recording adherence.

Activities of Daily Living↗
PubMed2003

A randomised trial of hip protector use by frail older women living in their own homes.

OBJECTIVES: To investigate the efficacy and effectiveness of hip protectors in frail community living older women. DESIGN: Randomised controlled trial. SETTING: Aged care health services in New South Wales, Australia. PATIENTS: 600 women 74 years of age or more (mean age 83 years), who had two or more falls or one fall requiring hospital admission in the previous year, and who lived in their own homes. INTERVENTION: Use of hip protectors. MAIN OUTCOME MEASURES: Adherence with use of hip protectors, falls, incidence of hip fracture, and adverse effects of use of hip protectors. RESULTS: Adherence was approximately 53% over the duration of the study and hip protectors were worn at the time of 51% of falls in the intervention group. The risk of hip fracture when falling while wearing hip protectors, compared with a fall with no hip protectors in place, was significantly reduced (relative risk (RR) 0.23, 95% confidence interval (CI) 0.08 to 0.67). On an intention to treat analysis, 21 and 22 hip fractures occurred in the intervention and control groups respectively (adjusted RR 0.92, 95% CI 0.51 to 1.68). Three users of hip protectors sustained a hip fracture while wearing properly applied protectors, while 16 hip protector users (5%) developed minor local complications. CONCLUSIONS: Hip protectors prevent hip fractures in community dwelling older women if worn at the time of a fall. The overall effectiveness of hip protectors was not established in this study, because of incomplete adherence with use of the protectors, and limited statistical power.

Accidental Falls↗
PubMed2001

Hip protectors in aged-care facilities: a randomized trial of use by individual higher-risk residents.

OBJECTIVES: To investigate the effect of use of external hip protectors on occurrence of hip fracture. DESIGN: Randomized controlled trial, with randomization at the individual level. SETTING: residential aged-care facilities in urban areas of New South Wales, Australia. PARTICIPANTS: 174 women, aged 75 years and older, who had had two or more falls or one fall requiring hospital admission in the previous 3 months, and who lived in hostels or nursing homes. Eighty-six subjects were in the intervention group and 88 in the control group. INTERVENTION: Use of external hip protectors and encouragement by nurses to use the protectors. MEASUREMENTS: Follow-up visits at approximately 2 weeks and 2, 10 and 18 months to determine falls and fall injury (including hip fracture); we also measured adherence to hip protector use. RESULTS: The mean age of participants was 85; they lived in 32 different aged-care facilities, two-thirds of which were nursing homes. Intervention and control groups had similar baseline characteristics, with a mean Barthel index of 58 at enrollment and a mean Short Portable Mental Status Questionnaire score of six errors, indicating severe disability and major cognitive impairment. During follow-up, a mean of 4.6 falls per person occurred. There was no difference in mortality, with 28 deaths in each group. Eight hip fractures occurred in the intervention group and seven in the control group (hazard ratio 1.46; 95% confidence interval 0.53-4.51). No hip fractures occurred when hip protectors were being worn as directed. Adherence was about 57% over the duration of the study and hip protectors were worn at the time of 54% of falls in the intervention group. Adherence varied markedly between institutions, but the greatest was about 80%. CONCLUSION: Hip protectors were not effective in reducing the incidence of hip fractures in this study, but because of low statistical power, a reduction in risk of hip fracture of up to 50% may not have been detected. There was limited adherence with their use, resulting in a large number of falls occurring without hip protectors in place. All hip fractures in the intervention group occurred when hip protectors were not being used.

Aged↗
PubMed2000

Quality of life related to fear of falling and hip fracture in older women: a time trade off study.

OBJECTIVE: To estimate the utility (preference for health) associated with hip fracture and fear of falling among older women. DESIGN: Quality of life survey with the time trade off technique. The technique derives an estimate of preference for health states by finding the point at which respondents show no preference between a longer but lower quality of life and a shorter time in full health. SETTING: A randomised trial of external hip protectors for older women at risk of hip fracture. PARTICIPANTS: 194 women aged >/= 75 years enrolled in the randomised controlled trial or who were eligible for the trial but refused completed a quality of life interview face to face. OUTCOME MEASURES: Respondents were asked to rate their own health by using the Euroqol instrument and then rate three health states (fear of falling, a "good" hip fracture, and a "bad" hip fracture) by using time trade off technique. RESULTS: On an interval scale between 0 (death) and 1 (full health), a "bad" hip fracture (which results in admission to a nursing home) was valued at 0.05; a "good" hip fracture (maintaining independent living in the community) 0.31, and fear of falling 0.67. Of women surveyed, 80% would rather be dead (utility=0) than experience the loss of independence and quality of life that results from a bad hip fracture and subsequent admission to a nursing home. The differences in mean utility weights between the trial groups and the refusers were not significant. A test-retest study on 36 women found that the results were reliable with correlation coefficients within classes ranging from 0.61 to 0.88. CONCLUSIONS: Among older women who have exceeded average life expectancy, quality of life is profoundly threatened by falls and hip fractures. Older women place a very high marginal value on their health. Any loss of ability to live independently in the community has a considerable detrimental effect on their quality of life.

Accidental Falls↗
PubMed2000

Hip protectors improve falls self-efficacy.

OBJECTIVES: To investigate the effect of use of external hip protectors on subjects' fear of falling and falls self-efficacy (belief in their own ability to avoid falling). DESIGN: Randomized controlled trial. SETTING: Aged-care health services in Sydney, Australia. PARTICIPANTS: 131 women aged 75 years or older, who had two or more falls or one fall requiring hospital admission in the previous year and who live at home. Sixty-one subjects were in the intervention group and 70 in the control group. INTERVENTION: Use of external hip protectors and encouragement to use the protectors by an adherence nurse. MEASUREMENTS: At the time of enrolment into a wider study examining the effect of hip protectors on hip fractures, participants recruited at home completed an assessment of fear of falling and falls efficacy as measured by the Falls Efficacy Scale and the Modified Falls Efficacy Scale. At 4-month follow-up, these scales were readministered by an observer who was not aware of the allocation of the participant to intervention or control groups. RESULTS: Fear of falling and falls self-efficacy, as measured by the Falls Efficacy and Modified Falls Efficacy Scales, were similar at baseline in both groups. Fear of falling was present at follow-up in 43% of subjects using hip protectors and 57% of the control group (chi2 = 2.58, P = 0.11). Hip protector users had greater improvement in falls self-efficacy at follow-up as measured by the Falls Efficacy Scale (t = 2.44, P = 0.016) and the Modified Falls Efficacy Scale (t = 2.08, P = 0.039). CONCLUSION: Hip protectors improve falls self-efficacy. As users of hip protectors feel more confident that they can complete tasks safely, they may become more physically active and require less assistance with activities of daily living.

Accidental Falls↗
PubMed1999

A case-control study of employment status and mortality in a cohort of Australian youth.

Recent studies have demonstrated a link in young populations between unemployment and ill health. The purpose of this study is to correlate mortality with employment status in two cohorts of young Australian males, aged 17-25 years, from 1984 to 1988. Two youth cohorts consisting of an initially unemployed sample (n = 1424 males) and a population sample (n = 4573 males), were surveyed annually throughout the study period. Those lost to follow-up during the survey period were matched with death registries across Australia. Employment status was determined from weekly diaries and death certificates and was designated as: employed or student; unemployed; not in the work force (excluding students). Conditional logistic regression, using age- and cohort- matched cases (deaths) and controls (alive), was used to estimate the odds ratio (OR) of dying with regard to employment status, taking into account potential confounders such as ethnicity, aboriginality, educational attainment, pre-existing health problems, socio-economic status of parents, and other factors. Twenty three male survey respondents were positively matched to death registry records. Compared to those employed or students (referent group), significantly elevated ORs were found to be associated with neither being in the workforce nor a student for all cause, external cause, and external cause mortality other than suicide. Odds ratios were adjusted for age, survey cohort, ethnicity, pre-existing physical and mental health status, education level, and socio-economic status of parent(s). A statistically significant increasing linear trend in odds ratios of male mortality for most cause groups was found across the employment categories, from those employed or student (lowest ORs), through those unemployed, to those not in the workforce (highest ORs). Suicide was higher, but not statistically significantly, in those unemployed or not in the workforce. Suicide also was associated, though not significantly, with the respondent not living with their parents when they were 14 years of age. No association was found between mortality and past unemployment experience, as measured by length of time spent unemployed, or the number of spells of unemployment experienced during the survey. The results of this study underscore the elevated risk to survival in young males as a consequence of being neither employed nor a student.

Adolescent↗
PubMed1999

Health concerns and expectations of Anglo and ethnic older Australians: a comparative approach.

Australia is a multicultural society in which the most rapidly ageing groups are immigrants, many of whom cannot speak English well. Minimal research has been conducted to identify ethnic variation in health concerns and expectations of older Australians from non-English-speaking backgrounds, necessary to facilitate culturally appropriate services. This paper presents findings from 12 focus group sessions (4 Anglo, 3 Italian, 2 Chinese, 2 Arabic, 1 Greek) with older (60+) Australians. Common areas of concern were inadequate medication information, labelling and instructions. Anglo participants differed from ethnic participants in their use of herbal remedies, language, relationship with pharmacist and doctor and awareness of health rights. Other concerns and expectations were specific to a particular ethnic group. The findings should increase health professionals' awareness of the similarities and differences which exist between mainstream Anglo and ethnic Australians, and also between ethnic groups, thereby avoiding the use of a blanket approach when communicating with, or planning policies for, ethnic older Australians.

Journal Article↗
PubMed1998

Attitudes to xenotransplantation: scientific enthusiasm, assumptions and evidence.

The use of xenografts could relieve the chronically inadequate supply of human organs for transplantation, but doubts have been expressed about the general acceptability of transplanting animal organs into human. Some researchers and clinicians have chosen to ignore negative attitudes towards clinical xenotransplantation, assuming that people will automatically embrace this new technology when it becomes available. A review of eight studies of attitudes to xenotransplantation did not reveal overwhelming support for it. Particularly negative views were expressed by acute care nurses. Primates have been the donors of choice in clinical xenotransplantation to date, but their continued use is a highly contentious option; the preferred animal donor is now clearly the pig. Animal farming for xenotransplantation is generally regarded as acceptable since animals provide food for man and are an accepted source of items for human use such as heart valves and insulin. Open debate about xenotransplantation must now take place, and present attitudes may change as a result of this. However, it remains to be seen whether xenografts will be widely accepted and used, and the extent to which the chronic shortage of organs for transplantation will thereby be alleviated.

Animal Rights↗
PubMed1997

Utilisation of Australian health care services by ethnic Chinese.

Australia is a multicultural society in which migrants from non-English-speaking backgrounds may be more vulnerable to illness after their new settlement, and language difficulties and cultural differences may affect their use of health services. The present qualitative study used focus group interviews to explore the health services used by Chinese migrants from Hong Kong and China. The general findings included strong preference for Chinese-speaking general practitioners, insufficient interpreter services, low use of preventive services, and lack of knowledge about the existence and role of ethnic health workers. The paper reports specific differences between migrants from China and Hong Kong, and by age group. It discusses reasons for these findings and notes the implications.

Adult↗
PubMed1996

Surveillance of traumatic spinal cord injury in Australia: the identification of information needs.

Monitoring the occurrence of disease through any surveillance program necessarily requires the expenditure of scarce resources. The type of information accessible through surveillance and how it may be obtained deserve careful consideration in order to justify these costs. Therefore before establishing a new system of surveillance it is advisable to ascertain the information needs of potential users and to determine the feasibility of developing a system to meet them. As part of the planning for a national traumatic spinal cord injury surveillance system in Australia these data were sought by conducting a survey of key informants in 1993. The planning and evaluation of health care services, a knowledge of spinal cord injury epidemiology and its sequelae, injury prevention, external demands for information, and facilitation of research, were identified as the most important needs for information. It has been shown that the prevalence of spinal cord injury in Australia is increasing. As this occurs the need for specialised health services will also rise. Therefore, to facilitate the rational planning of services, and to monitor the well-being of the Australian spinal cord injured population, accurate surveillance data are essential.

Australia↗
PubMed1996

Pharyngocutaneous fistula following total laryngectomy and post-operative vomiting.

The significance of post-operative vomiting as a risk factor in the development of a pharyngocutaneous fistula was examined. The case records of 50 consecutive patients undergoing laryngectomies (39 men, 11 women, average age 64 years) were examined, 17 also underwent a simultaneous radical neck dissection. A fistula developed in eight patients (16%) and the median time to its diagnosis was 11 days (range 3-15 days). Several potential risk factors were examined including age, gender, previous radiotherapy, TNM stage, differentiation of tumour, simultaneous radical neck dissection and also the occurrence of vomiting post-operatively. In this series of patients only vomiting in the early post-operative period appeared to be related to the development of a fistula (regression summary: R2 = 0.6, t-value 5.6, P < 0.0001). An episode of vomiting was recorded in eight patients and of these six (75%) subsequently developed a fistula. The median time of post-operative vomiting was 7.5 days (range 1-10 days) and the diagnosis of a fistula occurred at a mean of 1.2 +/- 0.4 days after the episode of vomiting. In a study of this nature it is not possible to conclude that a causal relationship exists between vomiting and fistula development. However, if this is the case a potential means of decreasing the incidence of fistulae following laryngectomy may be available.

Female↗
PubMed1996

Difficulties experienced by carers from non-English-speaking backgrounds in using health and other support services.

The proportion of the Australian population from non-English-speaking backgrounds is increasing (particularly among the elderly, who are more likely to be disabled), but their use of health care services and institutions is proportionately lower than that for other Australians, and many care for a family member with a disability or illness at home. The study objective was to document the experiences of such carers in using health and other support services in order to understand the reasons for underutilisation. This study differs from most other carer studies in concentrating on carers with little or no English, and by using a semistructured interview that enabled carers to describe their experiences and attitudes more openly. Forty women carers were interviewed, with bilingual interviewers or interpreters being used where necessary. Interviews were tape-recorded and content-analysed. The services used, sources of information and referral, and the reasons for not using a service were identified. Some of the difficulties experienced in using services were common to many carers, irrespective of background, whereas others related specifically to English language deficits and cultural differences. Carers were reluctant to institutionalise a family member, despite their own health problems, emphasising the need for greater support from existing and expanded services to enable the relative to be cared for at home.

Adult↗
PubMed1995

Burn injuries and characteristics of burn patients in New South Wales, Australia.

This study describes the burn injuries and characteristics of patients admitted to the major adult burn unit in New South Wales, Australia. Data were collected from the medical records of all patients admitted in the 30-month study period (184 persons, 143 (78 per cent) males, 41 (22 per cent) females). The findings identified that patients were most likely to be males, aged between 25 and 34 years, who experienced a 11-20 per cent total surface burn area flame injury whilst using an accelerant in a domestic environment. Patients were more likely to smoke tobacco, drink alcohol to hazardous levels and take prescribed psychotropic medications than the general population. Preburn morbid conditions were prevalent, especially in the females. The actions of patients who had sustained a non-intentional burn commonly indicated a lack of understanding of the danger of certain equipment or the combustibility and volatility of some materials and flame. Prevention appears to be the most effective way to reduce burn injury through education of at-risk groups. However, because of the multicausality identified in the study, other preventive measures, such as improvement in product safety design, are suggested. Some similarities and differences with studies reported from Australia and overseas are noted.

Accidents↗
PubMed1995

Australian trends in mortality by socioeconomic status using NSW small area data, 1970-89.

This ecological study examines trends in socioeconomic differentials in mortality in New South Wales, Australia, over a 20-year period (1970-89). The proportion unskilled was used as the indicator of socioeconomic status and its selection justified. Using census data aggregated by Local Government Area, the relationship between mortality and socioeconomic status was examined using quintiles based on the proportion unskilled in the population. Local Government Areas were also sorted into quintiles using mortality rates (0-74 years) to describe change in mortality differentials over time. Socioeconomic differentials were more evident in the relatively homogeneous Local Government Areas within the Sydney Statistical Division than in the remaining NSW Statistical Divisions which are more heterogeneous and predominantly rural. Although there has been an overall decline in mortality for males and females, and for high and low status groups, over this period the relative socioeconomic differentials have not declined. For the most recent period (1985-89) there appears to be some widening of differentials for males. The NSW state trends are generally similar to those reported for Britain and for other industrialised countries, suggesting that this is a common trend and that policies to reduce inequalities have not been effective.

Adolescent↗