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W Fidler

Publications and source records attributed to W Fidler.

5 recordsLinked to original sources
PubMed2001

A prescription for health: a primary care based intervention to maintain the non-smoking status of young people.

OBJECTIVES: To evaluate the effectiveness of primary health care teams in maintaining a group of young people aged 10--15 years as non-smokers. DESIGN: Randomised controlled trial using postal questionnaires. SETTING: Oxfordshire, UK. SUBJECTS: 2942 young people who were initially self declared non-smokers. INTERVENTION: Information about smoking, sent under signature of the subject's general practitioner, certificates and posters intended to reinforce non-smoking behaviour. MAIN OUTCOME MEASURES: Changes in smoking behaviour, attitudes measured after one year. RESULTS: After a year, smoking uptake was 7.8% in the control group compared with 5.1% in the intervention group (odds ratio (OR) 1.6, 95% confidence interval (CI) 1.1 to 2.2). Among boys the corresponding results were 5.2% and 2.4% (OR 2.3, 95% CI 1.2 to 4.6), and among girls 10.0% and 7.5% (OR 1.4, 95% CI 0.9 to 2.1). Among boys aged 14-15 the uptake rate was 12.8% in the control group compared with 5.4% in the intervention group. However, among girls of the same age the intervention was less effective, with smoking uptake of 15.1% in the control group and 12.8% in the intervention group. The intervention was more effective among young people whose initial attitudes identified them as definite non-smokers than those who were potential smokers. CONCLUSIONS: The intervention substantially reduced smoking uptake among the young people, particularly boys. Primary health care teams can play an important role in maintaining the non-smoking status of their young patients. Confidential postal contact from the doctor direct to the young person at home is influential and cost-effective.

Adolescent↗
PubMed1992

Smoking: a special need?

The smoking behaviour of 665 children aged 12-15 years with special educational needs was compared with that of a control group of 842 children in mainstream education. Each child was interviewed using a structured questionnaire and reported smoking behaviour was validated against scores on a carbon monoxide monitor. We identified as the most at risk group children with emotional and behavioural disorders. They had the highest smoking rates and were the heaviest smokers. In contrast, children with learning difficulties had slightly lower smoking rates than those of the control. There were significant associations between the children's smoking behaviour and the smoking behaviour of siblings and 'other adults' in the household, belonging to single parent families, low self-esteem and large friendship groups. The reported smoking rates of the families of both groups of special needs children was found to be considerably higher than that in the control group or in the general population.

Achievement↗
PubMed1977

Percutaneous needle localisation of breast lesions prior to biopsy: analysis of failures.

Mammography can detect clinically occult breast cancer. But with minimal or no physical findings the lesion can be quite difficult for the surgeon to find within the recumbent breast at biopsy. Percutaneous needle localisation, the placement of a needle in or in the vicinity of such a clinically silent lesion, provides an internal landmark to assist the surgeon. Review of our experience of 90 procedures using this technique disclosed a success rate of approximately 90%. The biopsies diagnosed 14 cancers before local or distant metastasis could be found. The eleven of the fourteen who had axillary dissection were found to have negative nodes. Identifiable causes of failure were sought and discussed in the 7 documented failures. Faulty needle placement was judged noncontributory in all but one case. Needle movement between time of placement and time of biopsy could never be excluded and is in fact suspected in two failures. Immediate re-sampling, or larger initial specimens would have salvaged the procedure in most instances of failure. We feel poor communication and poor mutual understanding of the localization procedure to be the major contributing cause of failure. Even so, we have been able to use the technique with 90% success. The development of mammography brought with it the opportunity to detect small non-palpable carcinomas and the surgical problem of removing them at biopsy. While the suspect lesions identified by mammography are frequently benign, the cancers found are usually small and some only microscopic in size. The literature contains many descriptions of various techniques for localising such lesions prior to biopsy. We are reporting our experience with percutaneous needle localisation. To our knowledge, we have the distinction of being the first to report difficulty with a localisation technique and will analyse possible reasons. Some of the problems are common to all the localisation techniques.

Adult↗