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Biomedical subjects

S Whitelaw

Publications and source records attributed to S Whitelaw.

11 recordsLinked to original sources
PubMed2001

'Settings' based health promotion: a review.

Over the past 10 years, 'settings' based health promotion has become a central feature of efforts to promote health that recognize the significance of context. Emerging in part from a perception of an over-reliance on individualistic methods, the approach was built on a profound belief in its value and deployed a range of novel theoretical resources, mainly from organizational sociology and psychology. This initial enthusiasm has been maintained within policy directives, in the published literature and, from our own experience, amongst health promotion practitioners. At the same time, with the maturing of the approach, has come a healthy element of critical review. Drawing upon the literature and based upon our experiences within the Health Education Board for Scotland, this paper seeks to bring together a range of perspectives, casting a critical yet constructive eye on current settings theory and practice. The paper first reviews the nature of settings based work, highlighting the varied bases and expectations that underpin it. Similarly, the many factors that influence the ability of health promoters to deliver such activities are considered. In relation to the construction and delivery of such activity, the paper suggests that there needs to be an explicit and detailed assessment of the nature of the setting, the skills of the health promoter and the associated expectations.

Health Promotion↗
PubMed2000

The status of evidence and outcomes in Stages of Change research.

The Stages of Change model has become a prominent feature within health promotion and most of the literature associated with the model portrays it as being 'effective'. Based on an extensive review of the literature, this paper suggests that contrary to this view, there exist a relative paucity of sufficiently strong supportive evidence. The paper describes the features of the existing evidence base, and highlights problems in relation to various aspects of design and execution. Two wider issues relating to the core nature of the model and the evidence associated with it are identified as important and discussed. Two main conclusions are drawn. First, better quality quantitative outcome studies are needed. These should be complemented with significant qualitative case studies with a focus on practitioner and organizational utilization of the model. Second, the disproportionate popularity of the model may be skewing the practical and conceptual nature of health promotion. Stages of Change activities are seen to equate to 'health promotion' at the expense of other activities and approaches.

Health Behavior↗
PubMed1997

Global health promotion models: enlightenment or entrapment?

This paper suggests that there is a tendency for health promotion to be located within models that consider health to be a product of a range of forces, with practice itself assumed to comprise a similarly wide range of activities. This paper develops a critique of this tendency that is essentially accommodating, all embracing and 'neutral'. It is argued that this leads to the masking of tensions between the conflicting values contained within the different elements of the models. We suggest that for health promoters, this is neither conceptually appropriate nor practically sensible. These notions are developed in five main stages. We start by defining some of the key concepts in the piece, e.g. the nature of a 'model' and examples of 'global' models. We then examine some of the general reasons why global models are favoured, with respect to the emergence of the UK's strategy for health, The Health of the Nation. The third stage of the discussion identifies and considers, within the British context, professional and governmental factors perceived to have driven this choice. The fourth aspect of the paper will introduce a critique of the use of global modelling. The paper concludes by critically questioning this evolving relationship, and suggests that it will be essentially conservative and unproductive. We end by reviewing the implications for practice and suggesting a useful way forward.

Health Policy↗
PubMed1996

Attitudes to predictive DNA testing in familial adenomatous polyposis.

Attitudes to predictive DNA testing for familial adenomatous polyposis were documented in 62 affected adults. Patient views on prenatal testing and termination of pregnancy for this disorder were sought, as were opinions on the most suitable age to offer predictive testing for at risk children and the most appropriate age to begin screening. While 15 (24%) of those questioned stated that they would proceed to termination of pregnancy if a prenatal test indicated that the unborn baby was affected, in clinical practice no one has yet requested this option. Six (10%) people who had refrained from having children for fear of passing on the polyposis gene felt that the arrival of prenatal testing would enable them to consider planning a family. The majority of patients (93%) said they would like their children tested by DNA analysis at birth or in infancy, but felt that 10 to 12 years was the most appropriate time to discuss the diagnosis with the child.

Abortion, Spontaneous↗
PubMed1995

Market testing specialist health promotion services--a test case for an imaginative public health presence in purchasing.

This paper focuses on the current pressure being imposed upon health promotion services in the 'North West' Region in the form of 'market testing'. It suggests that this is not only of concern to those services themselves, but may also act as a 'test case' for the examination of the range of competing perspectives that inform a purchasing function. The tensions between the views that respectively support or question the application of market values is thus examined in relation to the role of public health specialists within purchasing organizations. The paper concludes that although there is some potential to 'sharpen up' services, caution is required in avoiding unrestricted market values leading to superficial and fragmented health promotion provision. It is admitted that there are consequences relating to health promotion specialists. However, because of the close affinity between promotion and public health, failure to protect health promotion from the harshness of the market and ensure a broad-based approach will not only be a set-back for health promotion but will also harm the status of 'public health perspectives' in the broader purchasing context.

Contract Services↗
PubMed1995

Variables associated with the risk of colorectal adenomas in asymptomatic patients with a family history of colorectal cancer.

The results of screening individuals referred to the Family Cancer Clinic at St Mark's Hospital from 1986 are presented. Colonoscopy was performed in 644 asymptomatic individuals (from 436 families) with a family history of colorectal cancer. Sixty nine (15.8%) of the families fulfilled the Amsterdam criteria for the hereditary non-polyposis colorectal cancer syndromes (HNPCC). Seven cases of colorectal cancer were diagnosed at an average age of 49 years; six at Dukes's stage A and one at stage C, four in subjects from Amsterdam criteria families. One hundred and forty four (22.4%) subjects had one or more adenomas. The prevalence of adenomas in the subjects from Amsterdam criteria families was 34 of 127 (26.8%) compared with 110 of 517 (21.3%) in those from other families; the age and sex adjusted odds ratio (OR) was 1.76 (p = 0.02). Factors influencing the prevalence of adenomas in screened individuals were evaluated. Multivariate analysis showed that independent variables significantly related to the risk of adenomas were: age (p < 0.0001), sex (p = 0.0002), and the number of generations (> or = 2 v 1) of relatives affected by either colorectal cancer or adenomas (p = 0.0006). The latter variable was more highly predictive of the probability of finding an adenoma at colonoscopy than a family history of two generations with cancer only (p = 0.056). The OR of having colorectal adenomas increased with age, by about twofold for each decade, and was twice as high in men than women, and in subjects with two or more generations relative to those with one generation affected by colorectal cancer or adenomas. Six of seven patients with cancer and 46 of 144 (31.9%) with adenomas had lesions proximal to the splenic flexure only. The proportion of individuals with proximal adenomas only was 47.1% in Amsterdam criteria families and 27.3% in the others (p=0.03). These findings support the view that colonoscopy rather than sigmoidoscopy is the method of choice for screening high risk groups.

Adenoma↗
PubMed1988

Death from undiagnosed peptic ulcer complications: a continuing challenge.

A 10-year study of all 9653 autopsies performed in the Plymouth Health District, UK from 1977 to 1986 revealed 154 patients who died from undiagnosed peptic ulcer complications. In all, 118 of these patients died suddenly at home and 36 died in hospital. Most patients were elderly although 47 were under 70 years and 2 were under 50 years of age. Anti-inflammatory drugs were being used by 81 of these patients, an incidence of 60 per cent where full drug histories were available. Women who died were much more likely to be using these drugs than men. This study emphasizes the hitherto unrecognized importance of death from undiagnosed peptic ulcer disease and further highlights the potential risk of non-steroidal anti-inflammatory drug use.

Age Factors↗
PubMed1987

Clean intermittent self-catheterisation in the elderly.

The results of teaching the technique of clean intermittent self-catheterisation (CISC) to 20 elderly patients (aged 65-81 years) are reported. The patients were followed up for a maximum of 4 years. The use of this technique in the management of selected elderly patients with lower urinary tract dysfunction is discussed.

Aged↗