Biomedical subjects

S Redman

Publications and source records attributed to S Redman.

At least 55 records · Page 3Linked to original sources

PubMed1992

The use of portable blood glucose monitors by trained lay operators.

OBJECTIVE: To evaluate the use of Reflolux II blood glucose reflectance meters by trained lay operators in a community survey. DESIGN: A random household survey involving assessment of participants' blood glucose levels by Reflolux II. For a random subsample of participants an additional sample of blood was placed onto filter paper strips and stored for later examination and assay. SETTING: The survey was conducted in the Newcastle and Lake Macquarie areas of New South Wales. PARTICIPANTS: Of the 1275 participants 15 years and over, 1229 consented to have their blood glucose assessed and 163 of these also had blood stored on filter paper strips. Data were collected by 25 interviewers. MAIN OUTCOME MEASURES: Application of blood spots to filter paper assessed the interviewers' capacity to collect samples of minimal acceptability for Reflolux II operation. Samples were considered adequate if they covered at least a 6 mm soaked disk and there was no evidence that they had been smeared or applied from both sides of the paper. The Reflolux II readings obtained by the interviewers were compared with the blood glucose values from assay of the filter paper samples. RESULTS: Only 63% of the 163 samples collected on filter paper were of acceptable quality for adequate Reflolux II operation. The overall correlation between Reflolux II blood glucose values and those determined from the blood collected on filter paper was good (r = 0.893). However, three of the eight interviewers who had five or more readings for comparison achieved correlation coefficients of < r = 0.20. Of the survey participants identified as having elevated blood glucose levels (> 8 mmol/L) by the filter paper assay, 58% (7 of 12) were not detected by the lay operated reflectance meters. Twenty-two per cent of the individuals assessed by the reflectance meter, compared with 0.5% of a population sample surveyed by the National Heart Foundation, had blood glucose values of less than 3.5 mmol/L. CONCLUSION: It would appear that there may be a considerable error rate in blood glucose values obtained by lay operators using reflectance meters, resulting in underestimation of blood glucose levels. The findings have implications for community awareness programs for diabetes and highlight the need for careful training and monitoring of lay operators in their obtaining of finger-prick blood samples and their use of reflectance meters.

Adolescent↗

PubMed1992

Drug use in Australia: a community prevalence study.

OBJECTIVE: To estimate the prevalence of drug use in a representative Australian community. DESIGN: Using a Census district sampling framework supplied by the Australian Bureau of Statistics, we randomly selected dwellings for our survey. A household was defined as all those people living permanently at the postal address. All eligible members of each household, 15 years and older, were asked to participate. SETTING: The data were collected in the context of a large scale general population survey of health practices and attitudes, conducted in the Greater Newcastle area of New South Wales, during 1987 and 1988. PARTICIPANTS: Seventy-two per cent of eligible individuals approached (2623) agreed to participate in the survey. MAIN OUTCOME MEASURES: Participants were asked about their use of a number of drug types: medically prescribed drugs, non-prescription drugs, tobacco, alcohol and illicit drugs. For alcohol, only the results for use at a hazardous level according to the National Health and Medical Research Council guidelines are reported here. RESULTS: Seventy-eight per cent (95% confidence interval, 76%-80%) of the community sample reported having recently consumed at least one of these drug types. There were significant age and sex differences in drug use. A greater proportion of women and the older age groups (over 45 years) reported the use of both non-prescription and prescription medications than did men and the younger age groups. Conversely, a significantly greater proportion of men and the younger age groups reported the use of social and illicit drugs. CONCLUSION: The importance of regular, representative, methodologically comparable community studies of drug use is stressed, particularly in view of the inadequacy of the current routine sources of epidemiological data on drug use.

Adolescent↗

PubMed1992

Promotion of attendance for mammographic screening through general practice: a randomised trial of two strategies.

OBJECTIVE: To compare the effectiveness of two strategies--patient education and practitioner recommendation--in encouraging women to attend for mammographic screening. DESIGN: The study was a prospective randomised controlled trial. Women aged between 40 and 70 years attending a general practitioner participated in the study. Consenting, eligible women were randomly allocated to one of the two strategy groups. SETTING: The study was conducted in private general practice in Newcastle, New South Wales. PARTICIPANTS: The general practitioners who took part in the study were a non-random sample of practitioners: 20 were approached, two declined to participate, and five failed to begin recruitment, leaving 13 practitioners who took part in the study. A total of 302 women aged 40-69 were recorded as attending the surgeries during recruitment sessions. Twenty women did not consent to the study and 73 were ineligible. Thirty-four women were not given the intervention because the general practitioner forgot or did not have time. There were 92 women in the simple recommendation group and 83 women in the patient education group. INTERVENTIONS: An intensive patient education approach based on health belief principles was compared with a simple recommendation by the general practitioner that the woman have a mammogram. MAIN OUTCOME MEASURE: Attendance rates were calculated from screening service attendance records. RESULTS: No significant difference in attendance rates was observed between the two groups, 82% of the simple recommendation group and 91% of the patient education group attended for screening. CONCLUSIONS: These results suggest that mammographic screening can be effectively promoted in general practice without extensive patient education.

Adult↗

PubMed1992

Reduction of ischemic heart disease risk markers in the teenage children of heart attack patients.

BACKGROUND: Families of people with ischemic heart disease (IHD) are likely to share high levels of risk markers and to have similar lifestyle patterns. Teenage children in such families were the focus of a behavioral intervention program. METHODS: Families were randomly allocated to either an "early" or a "late" advice group. The late group and a third "control" group (consisting of families with no cardiovascular disease) received the intervention only after baseline measurements were repeated in all three groups at the end of 12 months. Pedigree analysis was used to compare changes across groups. RESULTS: The decrease in self-reported total fat intake was greater among teenagers in the early group (mean = -3.38, SE = 1.00) than among those in the late group (mean = -0.58, SE = 1.06), as was the decrease in saturated fat intake (mean = -2.46, SE = 0.56; mean = -0.54, SE = 0.60, respectively). These differences were statistically significant (P < 0.05). There were no differences between these groups for changes in total or high-density lipoprotein cholesterol levels. There was a statistically significant difference between the change in total cholesterol levels in the control group (mean = +0.08, SE = 0.07) and that in the late group (mean = -0.14, SE = 0.11). CONCLUSIONS: The intervention program appears to have made the teenagers aware of high-fat foods, as stated fat intake was significantly lowered, but it was not successful in decreasing blood cholesterol levels. Having a parent with IHD did, however, influence the teenagers' risk-related behavior, leading to a significant reduction in blood cholesterol levels.

Adolescent↗

PubMed1992

The cost and availability of devices for preventing childhood injuries.

Accidental injury is the major cause of death among Australian children. Many childhood injuries are preventable through the use of safety devices such as those recommended by the Child Accident Prevention Foundation of Australia (CAPFA). It has been suggested that poor availability and the high cost of obtaining and installing safety devices may contribute to their low rates of use among families with young children. This paper assesses the availability and cost of recommended safety devices in a medium sized city in Australia. Of the 17 devices recommended by the CAPFA only 10 were readily available in Newcastle. The cost of purchasing and installing all the devices recommended by CAPFA amounted to $1516, or 21.4% of the annual disposable income, after the purchase of necessities, of families with children and 75.5% of the annual disposable income, after purchase of necessities, of single parents. It is argued that the cost of safety devices may be prohibitively expensive, particularly for those most at risk of suffering from injury.

Accident Prevention↗

PubMed1992

Preventive health behaviours among parents of infants aged four months.

Six preventive health behaviours have been frequently identified as having the potential to reduce mortality and morbidity during infancy: breast-feeding until the age of six months; no solid food until after four months of age; immunisation against whooping cough, diphtheria, poliomyelitis and tetanus; the use of a baby capsule to restrain the infant when travelling in a motor vehicle; regular attendance at a health care provider for preventive health checks; and no maternal smoking. This study surveyed 191 primiparous women four months after the birth of their babies to explore the proportion of parents who perform the recommended preventive health behaviours and the association among the behaviours. Thirty-nine per cent of the women reported that they were no longer breast-feeding by the time their infant was four months old; 35 per cent had introduced solids before 16 weeks of age; 35 per cent did not always use a baby capsule when travelling with their baby in their car, 25 per cent did not regularly attend the early childhood health centres and 22 per cent smoked. Forty-eight per cent of the sample were performing four or fewer of the six preventive health behaviours and 21 per cent were performing three or fewer. The relationship between performing each preventive health behaviour and a range of demographic variables was investigated. A logistic regression indicated that performing three or fewer of the health behaviours was associated with lower levels of education, having public health insurance and being born in a country other than Australia.

Adult↗

PubMed1992

Delay in consulting a medical practitioner about rectal bleeding.

STUDY OBJECTIVE: The aims were to estimate the incidence of rectal bleeding in the community, and to determine the proportion of individuals who delay or fail to seek medical advice after a first episode of rectal bleeding. DESIGN: The data were collected as part of a large scale general population survey of the health practices and attitudes of individuals in a randomly selected sample of 2121 households. SETTING: The survey was conducted in the Newcastle and Lake Macquarie areas of New South Wales, Australia, during 1987-88. PARTICIPANTS: Information about rectal bleeding was collected from 1213 individuals aged 40 years and over. MEASUREMENTS AND MAIN RESULTS: Of the 1213 people aged 40 years and over, 239 (20%) reported noticing rectal bleeding at some time in their life. However, since an estimated 4.5% had noticed rectal bleeding for the first time in the past year the true lifetime incidence of rectal bleeding is likely to be much higher. Of the 77 individuals who had noticed a first occurrence of rectal bleeding more than three months but less than five years prior to the interview, 23 (30%) had either not sought medical advice or had only done so after a period of delay. The most commonly reported reason for delay or failure to consult was thinking that the bleeding was not serious and would clear up by itself. CONCLUSIONS: The data suggest that prompt investigation of rectal bleeding is not occurring in a relatively large proportion of cases. However, in the absence of firm evidence that early detection improves prognosis, and considering the costs of screening, it would be premature to initiate programmes which encourage people to seek care promptly for this symptom.

Adult↗

PubMed1992

Detection of alcohol-related problems in general practice.

While primary care has considerable potential as a site for detecting and intervening for alcohol-related problems, few doctors currently identify these problems. The judgments of eight primary care physicians about alcohol-related problems in 371 of their patients were compared with the patients' responses to the Short Michigan Alcoholism Screening Test (SMAST) and the CAGE. The CAGE classified 11.4% of the patients as alcoholics and the SMAST identified 23.9% as probable alcoholics. However, the doctors identified only a small proportion (7.0%) of their patients as having any level of alcohol-related problem. The doctors did not identify 65.0% of CAGE-defined alcoholics and 82.3% of those patients classified by the SMAST as probable alcoholics. The discrepancy between primary care physician's judgments and the SMAST and CAGE may be attributable to the doctor's failure to identify patients with alcohol-related problems. An alternative explanation is that the SMAST and CAGE are inappropriate screening tools for use in Australian primary care. The findings are discussed in terms of the implications for training doctors and for the development of better measures of alcohol-related problems for use within a primary care context.

Adolescent↗

PubMed1992

The reliability and stability of the Mortimer-Filkins test.

The Mortimer-Filkins test has been used widely as an instrument for detecting problem drinkers among drink-driving offenders. While extensive psychometric testing has been undertaken by the developers of the test, few independent validation studies have been conducted, and few studies have used the Mortimer-Filkins test with general populations. The present study investigated the test-retest and internal-consistency reliability of the instrument, and the stability of problem drinking, as measured by the instrument. The test was administered to moderate and heavy drinkers at an industrial workplace on three occasions. The results indicated that the Mortimer-Filkins test has high test-retest and internal-consistency reliability, and problem drinking, as measured by the test, appears to be a stable characteristic across time.

Accidents, Occupational↗

PubMed1992

Early detection of colorectal cancer: a profile of current practice.

This study examines the prevalence of colorectal cancer screening among individuals in the general community. The survey was undertaken as part of a large scale general population survey of health practices and attitudes. A sample of 1090 people aged 40 years and over with no previous history of colorectal cancer or other predisposing condition was interviewed. Only 56% of this group reported that they regularly checked their bowel movements, the toilet bowl, or the toilet paper for signs of rectal bleeding. Only 13% could recall a doctor ever advising them to check for rectal bleeding; and 21% could recall a doctor asking them if they had ever noticed blood in their bowel movements. More involved practitioner-based procedures, such as digital rectal examination, fecal occult blood testing, endoscopy, and barium enema, were reported by only a minority of participants. Analysis of screening rates in the 9.3% of people who reported a family history of colorectal cancer revealed that this higher risk group was no more likely to be screened than those at average risk.

Adult↗

PubMed1991

Screening for melanoma: a community survey of prevalence and predictors.

Australian cancer councils recommend the practice of regular self screening of the skin or screening by another person for signs of melanoma and other skin cancers. They also recommend that medical practitioners screen adult patients annually. This study examined the prevalence and predictors of self screening (or screening by another person) and screening by a general practitioner in 1344 individuals from randomly selected households. The results indicated that 48% of the sample either regularly checked their own skin or had it checked by another person (such as a spouse), and 17% had been screened by a general practitioner in the preceding 12 months. Overall, this indicates that 50% of the sample had their skin adequately screened as recommended. Individuals were less likely to have been screened if they were male; of lower occupational status; unemployed or too ill to work; and had only a primary school education. Those who had only basic medical insurance were also less likely to have been screened. A higher prevalence of screening was reported in individuals at greater risk of developing melanoma, in those who perceived themselves as more susceptible to developing melanoma, and in those who believed that there were greater benefits associated with the early detection of melanoma. The implications of these results for the development of effective public health education programmes, and for increasing the role of general practitioners in the education and screening of the public, are discussed.

Adolescent↗

PubMed1991

The effects of gender on diagnosis of psychological disturbance.

This research examines the effect of patient gender on the detection of psychological disturbance. In Study 1, primary-care patients were requested to complete the General Health Questionnaire (GHQ), a measure of nonpsychiatric psychological disturbance, prior to their consultation. The patient's GHQ score was compared with physician judgments about the level of disturbance in that patient (N = 1913). Although there were a similar number of GHQ high scorers among males and females, the physicians classified significantly more females than males as disturbed. The doctors classified as disturbed a larger proportion of nondisturbed women than nondisturbed men. In order to explore the behavior of recent medical graduates, Study 2 examined the detection behavior of interns in an outpatient department with 384 of their patients. The interns behaved in a similar manner to the primary-care physicians.

Adolescent↗

PubMed1991

The reliability and stability of a quantity-frequency method and a diary method of measuring alcohol consumption.

The study aimed to assess the test-retest reliability of two commonly used measures of alcohol consumption, the quantity-frequency (QF) method and the diary method, as well as the stability of scores on the two measures over time. Two methods of assessing reliability and stability were employed. The first was a traditional method based on calculation of correlation coefficients for agreement between scores on repeated measures over a short retest interval to yield test-retest reliability coefficients, and over a long retest interval to yield stability coefficients. The second method was that devised by Wiley and Wiley (1970) to differentiate the effects of reliability and stability on repeated measures over time. The two methods were applied to a sample of heavy drinkers and to a sample of light drinkers. The results indicated that both the QF and diary measures are reliable in measuring alcohol consumption of light drinkers. Both measures are less reliable for heavy drinkers. The results indicate, in addition, that drinking consumption levels of light drinkers demonstrate a high degree of stability. However, the consumption levels of heavy drinkers demonstrate less stability, especially over a long time period. Heavy drinkers significantly reduced reported levels of alcohol consumption on both measures after the first test, suggesting a regression to the mean effect or the possibility of unintended intervention effects due to repeated measurement of drinking behaviour.

Adult↗

PubMed1991

Training medical practitioners in information transfer skills: the new challenge.

Traditionally, undergraduate medical education has concentrated on teaching students how to gather information or take medical histories from their patients. However, research increasingly indicates that there is a need for medical practitioners to improve their skills in information transfer in a way which will increase the probability that patients are active collaborators in their treatment. Consequently, Newcastle Medical School has sought to develop training packages for medical students in information transfer skills. This paper describes the resulting training programme with particular emphasis on the areas selected for training, the methods by which students are taught, the necessary interactional skills and the assessment procedures which are applied.

Clinical Competence↗

PubMed1991

Self-reported long-term outcomes of hysterectomy.

OBJECTIVES: To investigate women's perceptions of and satisfaction with the long-term outcomes from a hysterectomy performed between 2 and 10 years ago and to determine whether satisfaction is related to demographic factors, factors associated with the hysterectomy, and the number or type of perceived benefits and problems associated with the hysterectomy. DESIGN: Retrospective survey by telephone interview and postal questionnaire of 236 women who had a hysterectomy between 2 and 10 years ago. SETTING: Women who had had a hysterectomy were identified from a community survey in the Hunter Region of NSW, Australia. SUBJECTS: Two hundred and thirty-six women who self-reported having had a hysterectomy between 2 and 10 years ago. MAIN OUTCOME MEASURES: Perceived benefits resulting from the hysterectomy; perceived physical and psychological problems caused by the hysterectomy; satisfaction with care. RESULTS: Relief from heavy bleeding was the most frequent benefit (57%) and the most important benefit (32%). Most of the women reported improvements in symptoms experienced before hysterectomy but more than half the women had symptoms which they believed had been worsened or caused by the hysterectomy. Despite this, high levels of satisfaction with the operation were reported. CONCLUSION: The results highlight the need to examine more closely decision-making about treatment for menstrual symptoms such as heavy bleeding.

Adult↗

PubMed1991

Prevalence and characteristics of women who have had a hysterectomy in a community survey.

A community survey of 8,896 households was undertaken in the Hunter region of New South Wales to assess women's health status. Consent was gained from 5,781 of the 6,361 eligible women between 18 and 69 years of age. The prevalence of hysterectomy in this sample was 16.9%, with 34.2% of women in their fifties having had a hysterectomy. Most hysterectomies (75%) were performed on women between the ages of 30 and 49 years. The demographic variables of parent's country of birth, educational level and employment status predicted recent hysterectomies after controlling for the effect of age.

Adolescent↗

PubMed1991

Evaluation of an antenatal education programme: characteristics of attenders, changes in knowledge and satisfaction of participants.

The evaluation of the efficiency and effectiveness of antenatal education programmes has been identified as a priority in improving maternity services in Australia. Two hundred and ninety four primiparas completed a brief questionnaire in the 3 days following delivery; 82% of the women surveyed attended antenatal education classes. Women were less likely to attend if they were single, younger than 26 years, had lower levels of education, received care during pregnancy from the antenatal clinic and did not have private health insurance. Attenders at antenatal education were also more likely to plan on breast feeding, to be nonsmokers and to know of a greater number of community organizations to help new mothers. However, logistic regression analyses indicated that, with the exception of number of community organizations known, these differences were attributable to demographic differences between attenders and nonattenders. One hundred and forty two women and their partners attending the major provider of antenatal education classes in Newcastle were surveyed prior to and following classes. Significant increases in knowledge were evident following the programme among both women and their partners. Satisfaction with the programme was high as indicated by a large proportion of respondents attending all 4 classes, most programme components being reported as useful or very useful and only a small proportion of respondents experiencing problems with the programme.

Adult↗

PubMed1991

A community study of delay in presenting with signs of melanoma to medical practitioners.

In the absence of more effective treatment for advanced tumors, early diagnosis and treatment of localized tumors is the most effective way of reducing the burden of illness associated with melanoma. This study examined the following factors: prevalence of signs of melanoma (a mole changing in size, shape, appearance, or color, itching or tingling, bleeding or weeping, becoming raised) in 1344 individuals in a randomly selected sample of 1075 households; the length of delay in seeking medical advice; the factors associated with either going to a medical practitioner or not going/delaying; and the actions of the medical practitioners when first presented with these signs. The results indicate that a large proportion of the sample (11.9%, n = 156) had observed signs of melanoma in the previous 12 months. Of the sample reporting signs that had first appeared in the previous 5 years, only 32% sought medical advice about the signs within the recommended period. Of the sample either not seeking advice at all or delaying, 49% reported that they thought the sign "wasn't serious/would clear up." Furthermore, 30% of the sample either did not known or underrated the importance of early detection and treatment of lesions. These results indicate that there is a deficit in the knowledge of the general public about the signs of melanoma, the severity of the disease, and the possible risks associated with delay.

Adolescent↗