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Biomedical subjects

S Redman

Publications and source records attributed to S Redman.

At least 37 records · Page 2Linked to original sources
PubMed1995

Smoking cessation in pregnancy: a survey of the medical and nursing directors of public antenatal clinics in Australia.

Smoking is a major cause of adverse pregnancy outcomes. However limited data are available documenting the perceptions of care providers in this area. This mail survey undertaken in 1992-1993 aimed to assess the smoking cessation practices of Australian public antenatal clinics. Questionnaires were returned by 140 (80%) of the 175 eligible hospitals, 83 (48%) medical directors and 108 (62%) nursing directors. Smoking advice was rated an essential activity at the first antenatal visit by 69% of responding directors. Nonetheless, only 12% of clinics indicated they offered relevant training and 4% reported written policies. Results also indicate senior staff may have suboptimal levels of awareness of smoking risks. Clinics used a narrow array of strategies to promote cessation. Almost one-third of directors said they advised smokers to cut down rather than stop smoking completely. There is a need for antenatal clinics to implement integrated strategies for the detection and treatment of pregnant smokers including staff training and modifications to the clinics' environment. In addition, major health promotion agencies need to develop effective smoking cessation programmes designed specifically for use in antenatal clinics and to monitor their on-going implementation.

Australia↗
PubMed1995

Setting targets: a three-stage model for determining priorities for health promotion.

This paper describes a three-stage model for setting targets for health promotion. The model was developed in 1992 in response to the need to identify priority areas for health promotion for women in the Hunter Region of New South Wales. The approach enabled epidemiological data and views from the community to be synthesised and integrated with those of experts from health and social services (key informants), using a nominal group process. The reliability of the method was investigated by replicating the process with two groups of key informants. There was considerable commonality in the targets generated by the two groups. The process resulted in the identification of seven targets that reflected the concerns of the community and local experts as well as the health priorities suggested by local epidemiological data. The model used could be adapted for determining priorities in a wide range of health and health care settings, where available resources restrict the range of services or activities which can be offered.

Consumer Organizations↗
PubMed1995

Domestic violence experienced by women attending an accident and emergency department.

The aim of the study was to establish the extent and severity of domestic violence experienced by women attending the accident and emergency department of a large teaching hospital in Newcastle. The data were collected over a five-week period in 1992. All women between 17 and 80 years, attending the emergency or ambulatory areas between 8 a.m. and midnight, were asked to complete a confidential structured interview. A total of 401 women participated in the study, representing 82 per cent of eligible women approached. Each participant was asked if she had ever been physically hurt by someone close to her. Questions were asked to determine the relationship to the perpetrator, the type and cause of injury, treatment necessary and help sought. Seven (1.7 per cent, 95 per cent confidence interval (CI) 0.46 to 3.02) of the women surveyed were attending the hospital as a direct result of an incident of domestic violence, and 100 women (25 per cent, CI 21 to 29) had experienced domestic violence at some time. Bruising, fractures and cuts were the most common forms of injury, with the most common locations being the head, face and chest. Weapons, such as guns and knives, were used in 20 per cent of the incidents. A considerable number of the women (68 per cent) did not seek help at the time of their injuries. As a substantial proportion of women have experienced domestic violence in their lives, accident and emergency workers should receive training in recognising and assisting victims of domestic violence.

Adolescent↗
PubMed1995

Professional needs of palliative care nurses in New South Wales.

A survey of 108 palliative care nurses practising in New South Wales, Australia, was undertaken to explore their professional needs and clinical knowledge. Opportunity for improved training was the most frequently nominated professional need. Only 12% of the sample had postgraduate qualifications in palliative care and fewer than 20% were currently undertaking postgraduate training. Sixty-three per cent of nurses indicated that a lack of opportunity for formal study was a problem for them. The results of the knowledge survey revealed a need for additional training. Many nurses did not have the clinical knowledge identified as minimal by an expert committee. Those nurses who had a postgraduate qualification in oncology scored more highly on the knowledge questionnaire than did those whose general nursing training was undertaken outside Australia. The implications of these findings for training and other professional support are discussed.

Adult↗
PubMed1995

A randomised controlled trial of strategies to prompt attendance for a Pap smear.

OBJECTIVE: To assess the comparative efficacy, by randomised controlled trial, of three interventions designed to encourage "at risk" women to have a Pap smear: an educational pamphlet; letters inviting attendance at a women's health clinic; and letters from physicians. METHODS: Subjects at risk for cervical cancer who had not been adequately screened were identified by a random community survey and randomly allocated to one of the intervention groups or a control group. Six months after intervention implementation, a follow up survey assessed subsequent screening attendance. Self report was validated by comparison with a national screening data base. RESULTS: A significantly greater proportion of women (36.9%) within the group receiving a physician letter reported screening at follow up than in any other group (P = 0.012). The variables most strongly predicting screening attendance were: age, perceived frequency of screening required, use of oral contraceptives, and allocation to receive the physician letter intervention. CONCLUSIONS: The relative efficacy of the GP letter in prompting screening attendance shows that this strategy is worthy of further investigation. There remains a need to examine the barriers to screening for older women, and to develop tailored strategies for this population.

Adolescent↗
PubMed1995

Public understanding of medical screening.

AIM: To estimate the extent of public understanding of mass screening for disease and of the benefits and limitations of screening. METHODS: Telephone interviews were conducted with a national sample of 835 Australians. RESULTS: Of total respondents, 68% claimed to have heard of screening tests, but only 21% correctly understood that screening tests are for asymptomatic people. This understanding was related to education. The most frequently named tests were mammography (51%) and Pap tests (33%), and for all age groups these were mentioned by more women than men. Around 27% of respondents thought that the Pap test would detect 95% or more of case, 45% thought the test would detect 90% or more, while 60% of respondents thought the test would detect 80% or more of cases. Around 29% of respondents thought that mammography would detect 95% or more of cases, 49% thought the test would detect 90% or more, while 65% of respondents thought the test would detect 80% or more of cases. Of all respondents, 33% favoured compensation when cases were "missed" by screening provided people were warned beforehand, 58% were not in favour, and 9% were unsure. CONCLUSIONS: There are misconceptions among the public concerning the purpose of screening and the accuracy of screening tests. However, most people accept that some cases of disease will be missed by screening and that if people are adequately informed beforehand compensation should not automatically follow for those whose disease is missed.

Adolescent↗
PubMed1994

Notification and follow-up of Pap test results: current practice and women's preferences.

BACKGROUND: This study aimed to determine women's knowledge of their Pap test results and predictors of accurate knowledge, adherence to follow-up recommendations for abnormal results, current methods of notifying women about their Pap test results, women's preferences for notification method, and women's satisfaction with the current notification system. METHOD: A telephone survey was undertaken of 315 women with a recent normal or abnormal Pap test result, drawn from pathology records in Sydney, Australia. RESULTS: Findings revealed that 61% of women with a normal result and 93% of women with an abnormal result self reported having been notified about their result. According to women's reports, 7% of those with abnormal results had not been notified and a further 11% of women with abnormal results were unaware that their result was abnormal, giving a total of 18% of abnormal results not communicated adequately to women. Self-reported adherence with follow-up recommendations among women with an abnormal result was less than optimal. The most common methods of notifying women of their results were initiated by the women such as the woman phoning the doctor or receptionist. However, women strongly preferred doctor-initiated methods, such as a written record from the doctor, the doctor phoning the woman, or consultation with the doctor. CONCLUSION: Results suggest that better methods of notifying and educating women about their Pap test results are necessary to improve women's knowledge and satisfaction and, even more importantly, to improve their level of adherence with follow-up recommendations for abnormal results.

Adult↗
PubMed1994

Statistical analysis of synaptic transmission: model discrimination and confidence limits.

Procedures for discriminating between competing statistical models of synaptic transmission, and for providing confidence limits on the parameters of these models, have been developed. These procedures were tested against simulated data and were used to analyze the fluctuations in synaptic currents evoked in hippocampal neurones. All models were fitted to data using the Expectation-Maximization algorithm and a maximum likelihood criterion. Competing models were evaluated using the log-likelihood ratio (Wilks statistic). When the competing models were not nested, Monte Carlo sampling of the model used as the null hypothesis (H0) provided density functions against which H0 and the alternate model (H1) were tested. The statistic for the log-likelihood ratio was determined from the fit of H0 and H1 to these probability densities. This statistic was used to determine the significance level at which H0 could be rejected for the original data. When the competing models were nested, log-likelihood ratios and the chi 2 statistic were used to determine the confidence level for rejection. Once the model that provided the best statistical fit to the data was identified, many estimates for the model parameters were calculated by resampling the original data. Bootstrap techniques were then used to obtain the confidence limits of these parameters.

Algorithms↗
PubMed1994

Statistical models of synaptic transmission evaluated using the expectation-maximization algorithm.

Amplitude fluctuations of evoked synaptic responses can be used to extract information on the probabilities of release at the active sites, and on the amplitudes of the synaptic responses generated by transmission at each active site. The parameters that describe this process must be obtained from an incomplete data set represented by the probability density of the evoked synaptic response. In this paper, the equations required to calculate these parameters using the Expectation-Maximization algorithm and the maximum likelihood criterion have been derived for a variety of statistical models of synaptic transmission. These models are ones where the probabilities associated with the different discrete amplitudes in the evoked responses are a) unconstrained, b) binomial, and c) compound binomial. The discrete amplitudes may be separated by equal (quantal) or unequal amounts, with or without quantal variance. Alternative models have been considered where the variance associated with the discrete amplitudes is sufficiently large such that no quantal amplitudes can be detected. These models involve the sum of a normal distribution (to represent failures) and a unimodal distribution (to represent the evoked responses). The implementation of the algorithm is described in each case, and its accuracy and convergence have been demonstrated.

Algorithms↗
PubMed1994

The prevalence of drug use in urban aboriginal communities.

The use of both licit and illicit drugs has been identified as a major health issue for Australian Aborigines. However, data on the proportion of people who use such drugs is scant. This cross-sectional survey of a randomly selected sample of urban Aboriginal people provides information on the use of the drugs alcohol, tobacco, marijuana, cocaine, heroin as well as petrol sniffing. Overall, a significantly smaller proportion of Aboriginal people were found to be current alcohol drinkers compared to non-Aboriginal Australians. A larger proportion of these drinkers were, however, found to be drinking at levels that were hazardous to their health. A significantly greater proportion of people from the Aboriginal sample were also found to be smokers compared to their non-Aboriginal counterparts. An examination of the use of the illicit substances revealed that a greater proportion reported they had ever used marijuana, compared to the other substances. The findings are discussed in terms of their implications for the health of Aboriginal people.

Adolescent↗
PubMed1994

Determinants of career choices among women and men medical students and interns.

Women continue to be poorly represented in medical specialties other than general practice. A cross-sectional design was used to explore the development of career plans as medical training progressed; men and women students were compared in their first (n = 316), final (n = 295) and intern (n = 292) years. Women at each stage of training were significantly more likely to choose general practice as the field in which they were most likely to practise. There was little evidence that these differences were influenced by experience during training: women were as likely to choose general practice in first year as in the intern year. The most important determinant of career choice appeared to be the flexibility of training and of practice of medicine: variables such as the opportunity for part-time training, flexible working hours and part-time practice were important determinants of career choice and were of more importance to women than to men. The study also found high rates of discrimination or harassment reported by women medical students and interns. The results indicate the need for continued debate about these issues within medicine and the development of more flexible styles of medical training and practice.

Career Choice↗
PubMed1994

A simulation of action potentials in synaptic boutons during presynaptic inhibition.

1. During presynaptic inhibition, an increased conductance in the membrane of the presynaptic bouton is presumed to reduce the action potential, thereby reducing transmitter release. The object of the simulation has been to determine the magnitude of a chloride conductance required to reduce transmitter release, for various diameters of synaptic boutons, connected to axons with diameters in the range 0.1-1.0 microns. 2. A propagating action potential was simulated in axons connected to either side of a hemispherical bouton. The axons could be myelinated or unmyelinated, while the bouton membrane could be passive, a node of the myelinated nerve, or have the same active properties as the attached unmyelinated nerve. Membrane properties of the axons were derived from mammalian data and scaled to 37 degrees C. 3. A steady-state chloride conductance was included in the bouton membrane, with ECl = -40 mV. The amplitude of the action potential in the bouton was calculated for different diameters of axon and bouton and for different magnitudes of chloride conductance. 4. Using published data on the relationship between the amplitude of a presynaptic action potential and the resulting postsynaptic potential, the relationship between the chloride conductance and the postsynaptic response was calculated for different geometries. Transmitter release was reduced when an action potential was 90 mV or smaller, with no transmission for action potentials smaller than 50 mV. 5. Conductance increases in the range 3 to 10 nS were required to reduce the action potential to 90 mV, depending on the diameter of the axon (0.5-1.0 microns), diameter of the bouton (3-6 microns), whether the bouton had passive or active membrane, and whether the axon was myelinated or unmyelinated. A 3 microns passive bouton connected to a 0.5 micron myelinated axon was most sensitive to the effects of a chloride conductance, while a 6 microns active bouton connected to a 1 micron myelinated nerve was least sensitive to the effects of a chloride conductance. 6. The reduction in the action potential was compared when ECl = -40 mV and when ECl = E(rest) = -80 mV. Inactivation of the sodium conductance by terminal depolarization was the dominant influence on the amplitude of the action potential. 7. Conductances that were sufficient to completely block synaptic transmission at a bouton were insufficient to prevent the spread of the action potential away from that bouton.(ABSTRACT TRUNCATED AT 400 WORDS)

Action Potentials↗
PubMed1994

Electrotonic profiles of interneurons in stratum pyramidale of the CA1 region of rat hippocampus.

1. Whole-cell recordings have been made from interneurons located in stratum pyramidale in the CA1 region of the hippocampus. The responses of these interneurons to brief current pulses were recorded; the neurons were filled with biocytin and their morphology was reconstructed. 2. The interneurons were identified as basket cells on the basis of the regional distribution of their axon collateral network and their location in stratum pyramidale. 3. A compartmental model of the reconstructed neuron was made, and the specific membrane resistivity (Rm), specific cytoplasmic resistivity (Ri), and somatic shunt leakage resistance (Rs) determined by adjusting these parameters until an optimal fit was obtained between the compartmental model's current pulse response and the recorded current pulse response of the neuron. 4. This procedure was successful for six neurons, giving Rm from 7 to 66 k omega cm2, Ri from 52 to 484 omega cm, and Rs from 84 M omega to infinity. The specific membrane capacitance was assumed to be 1 microF/cm2. The electrotonic length of the apical dendrites was 1.06 +/- 0.4, and for the basal dendrites it was 0.51 +/- 0.26 (mean +/- SD). 5. Although the total surface area of the interneurons and the physical length of their dendrites was much smaller than for CA1 pyramidal neurons, their electrotonic profiles were similar. Neurons with small physical profiles cannot be assumed to be more electrotonically compact than larger neurons, especially if the dendrites of the smaller neurons have a proportional reduction in diameter. 6. Two neurons did not require a somatic leakage conductance in their electrical representation. This suggests that when a somatic leakage conductance is required, it is an artifact resulting from electrode damage, rather than a requirement caused by a lower resistivity of the somatic membrane compared with the dendritic membrane. 7. Simulations of synaptic currents evoked in the dendrites of these interneurons while the soma is voltage clamped indicate large errors will occur in the time course measurements and amplitude of these currents. Also the ratio of N-methyl-D-aspartate:alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (NMDA:AMPA) currents at these synapses calculated from currents recorded at the soma will be in error because of the differential attenuation of the faster AMPA currents compared with the NMDA currents.

Animals↗
PubMed1994

Effectiveness of three community based strategies to promote screening for cervical cancer.

OBJECTIVE: Evaluation of three potential methods for increasing Pap smear use: television media, television media combined with letter based recruitment, and television media combined with general practitioner based (GP based) recruitment. SETTING: A trial of each intervention was carried out in three postal regions in New South Wales, Australia-a rural locality (containing about 1000 women), a country town (about 3000 women), and a major rural centre (about 10,000 women). Three control regions were selected to be demographically similar to the corresponding intervention regions. METHODS: Outcome data on regional Pap smear rates were obtained from government health insurance claims for cervical screening, and from pathology service records. Expected Pap smear rates for the three months after the intervention were predicted from 45 pre-intervention months and were compared with observed rates for this period. RESULTS: Television media alone was associated with a significant increase in attendances for screening in one of the three regions where a trial was carried out: 13.3% in the rural centre. The media/letter based campaign was associated with a significant increase in attendances in two out of three regions: 52.7% in the rural locality, 43.2% in the rural centre. The media/GP based campaign was associated with significant increases in attendances in all three regions: 50.2% in the rural locality, 80.8% in the country town, 15.7% in the rural centre. All three interventions were associated with significant increases in the number of women attending for cervical screening above those observed in the control regions. Furthermore, these increases were not restricted to women at low risk. They were also found for older women (aged 50-69 years) and women who had not had a Pap smear within the past three years.

Aged↗
PubMed1994

The relationships between high-risk and problem drinking and the occurrence of work injuries and related absences.

A review of studies on the relationship between alcohol and work injuries revealed that the evidence is contradictory and that many of the studies contain methodological flaws. The present study aimed to determine whether there are relationships between problem drinking and high alcohol consumption and outcomes such as work injuries and related absences. The sample consisted of 833 employees at an industrial worksite. Problem drinking was measured by the Mortimer-Filkins test, while alcohol consumption was measured by a 7-day retrospective diary. Work injury data were obtained from medical reports completed at the worksite medical center, while absences data were obtained from company records. Chi-square analyses revealed significant relationships between problem drinking and work injuries and injury-related absences, but not between high alcohol consumption and work injuries and related absences. Logistic regression analysis revealed that no variables were significant predictors of work injuries. However, when uninjured subjects were excluded, a second analysis revealed that Mortimer-Filkins test scores, recent stressful life events, age and job satisfaction were significant predictors of two or more injuries. Injured subjects were almost twice as likely to have two or more injuries if they had high numbers of recent stressful life events and low levels of job satisfaction. Logistic regression analysis revealed that age, Mortimer-Filkins test categories and job satisfaction significantly predicted injury-related absences. Problem drinkers were 2.7 times more likely to have injury-related absences than non-problem drinkers, and subjects with low levels of job satisfaction were 2.2 times more likely than others to have injury-related absences. The implications of the results for workplace alcohol policies and programs are discussed.

Absenteeism↗
PubMed1994

The role of general practitioners in the control of breast cancer.

Studies demonstrate that general practitioners have a vital role in the management of women with breast cancer. This includes encouraging women over 35 years to practise breast self examination, those over 40 to have annual breast checks, and those over 50 to have two-yearly mammography.

Adult↗