Clustered randomised trial of an intervention to improve the management of asthma: Greenwich asthma study. (17/5627)

OBJECTIVES: To evaluate the effectiveness of an asthma resource centre in improving treatment and quality of life for asthmatic patients. DESIGN: Community based randomised controlled trial. SETTING: 41 general practices in Greenwich with a practice nurse. SUBJECTS: All registered patients aged 15-50 years. INTERVENTION: Nurse specialists in asthma who educated and supported practice nurses, who in turn educated patients in the management of asthma according to the British Thoracic Society's guidelines. MAIN OUTCOME MEASURES: Quality of life of asthmatic patients, attendance at accident and emergency departments, admissions to local hospitals, and steroid prescribing by general practitioners. RESULTS: Of 24 400 patients randomly selected and surveyed in 1993, 12 238 replied; 1621 were asthmatic of whom 1291 were sent a repeat questionnaire in 1996 and 780 replied. Of 24 400 patients newly surveyed in 1996, 10 783 (1616 asthmatic) replied. No evidence was found for an improvement in asthma related quality of life among newly surveyed patients in intervention practices compared with control practices. Neither was there evidence of an improvement in other measures of the quality of asthma care. Weak evidence was found for an improvement in quality of life in intervention practices among asthmatics registered with study practices in 1993 and followed up in 1996. Neither attendances at accident and emergency departments nor admissions for asthma showed any tendency to diverge in intervention and control practices over the study period. Steroid prescribing rates rose steadily during the study period. The average annual increase in steroid prescribing was 3% per year higher in intervention than control practices (95% confidence interval -1% to 6%, P=0.10). CONCLUSIONS: This model of service delivery is not effective in improving the outcome of asthma in the community. Further development is required if cost effective management of asthma is to be introduced.  (+info)

Occupational stress in human computer interaction. (18/5627)

There have been a variety of research approaches that have examined the stress issues related to human computer interaction including laboratory studies, cross-sectional surveys, longitudinal case studies and intervention studies. A critical review of these studies indicates that there are important physiological, biochemical, somatic and psychological indicators of stress that are related to work activities where human computer interaction occurs. Many of the stressors of human computer interaction at work are similar to those stressors that have historically been observed in other automated jobs. These include high workload, high work pressure, diminished job control, inadequate employee training to use new technology, monotonous tasks, por supervisory relations, and fear for job security. New stressors have emerged that can be tied primarily to human computer interaction. These include technology breakdowns, technology slowdowns, and electronic performance monitoring. The effects of the stress of human computer interaction in the workplace are increased physiological arousal; somatic complaints, especially of the musculoskeletal system; mood disturbances, particularly anxiety, fear and anger; and diminished quality of working life, such as reduced job satisfaction. Interventions to reduce the stress of computer technology have included improved technology implementation approaches and increased employee participation in implementation. Recommendations for ways to reduce the stress of human computer interaction at work are presented. These include proper ergonomic conditions, increased organizational support, improved job content, proper workload to decrease work pressure, and enhanced opportunities for social support. A model approach to the design of human computer interaction at work that focuses on the system "balance" is proposed.  (+info)

Why are infertile patients not using psychosocial counselling? (19/5627)

The purpose of this study was to examine the sources of support that infertile patients relied on when distressed, and the factors that prevented them from using psychosocial counselling. The sample consisted of 143 infertile patients (49 couples plus 45 additional women) who were in their mid-thirties and had been infertile for approximately 6 years. Before their clinic appointment, participants completed (anonymously) a short questionnaire concerning various sources of support and factors related to the uptake of counselling. The results showed that patients relied primarily on their spouse and family when distressed, rather than on formal support resources such as psychosocial counselling. The principal reason preventing patients from using counselling varied as a function of current distress level. Less distressed patients reported that the coping resources available to them were sufficient to cope with the strains of infertility, while the more distressed patients failed to initiate contact with a counsellor because of practical concerns such as knowing who to contact and/or the cost of counselling. The findings of this study indicate that alternative ways of intervening with infertile patients would need to be developed, as few use the type of psychosocial services most frequently offered.  (+info)

Building momentum: an ethnographic study of inner-city redevelopment. (20/5627)

OBJECTIVES: One factor contributing to the decay of inner-city areas, and to consequent excess mortality, is the massive loss of housing. This report studied the effects of a redevelopment project on social functioning in an inner-city community. METHODS: This ethnographic study included the following elements: a longitudinal study of 10 families living in renovated housing, repeated observations and photographing of the street scene, focus groups, and informal interviews with area residents. The project was located in the Bradhurst section of Harlem in New York City and was focused on a redevelopment effort sponsored by local congregations. RESULTS: Those who were able to move into newly renovated housing found that their living conditions were greatly improved. Neighborhood revitalization lagged behind the rehabilitation of individual apartment houses. This uneven redevelopment was a visual and sensory reminder of "what had been." Residents missed the warmth and social support that existed in Harlem before its decline. CONCLUSIONS: Rebuilding damaged housing contributes greatly to the well-being of inner-city residents. The current pace and scope of rebuilding are insufficient to restore lost vitality.  (+info)

Shift work, risk factors and cardiovascular disease. (21/5627)

The literature on shift work, morbidity and mortality from cardiovascular disease, and changes in traditional risk factors is reviewed. Seventeen studies have dealt with shift work and cardiovascular disease risk. On balance, shift workers were found to have a 40% increase in risk. Causal mechanisms of this risk via known cardiovascular risk factors, in relation to circadian rhythms, disturbed sociotemporal patterns, social support, stress, behavior (smoking, diet, alcohol, exercise), and biochemical changes (cholesterol, triglycerides, etc) are discussed. The risk is probably multifactorial, but the literature has focused on the behavior of shift workers and has neglected other possible causal connections. In most studies methodological problems are present; these problems are related to selection bias, exposure classification, outcome classification, and the appropriateness of comparison groups. Suggestions for the direction of future research on this topic are proposed.  (+info)

Multidimensional assessment of elderly people in the community. (22/5627)

Multidimensional assessment has been advocated as the most appropriate type of screening activity for elderly people. The emphasis has traditionally been on screening for problems with function, disability and dependency in order to identify service and treatment needs. Several randomised trials of multidimensional assessment have been conducted. The UK trials have been conducted in the setting of general practice, while trials in other European countries as well as the US have targeted elderly people living in the community. Although there appear to be possible benefits from multidimensional assessment, for example in reduced mortality, disability and hospital inpatient admissions, these trials have not been consistent in their findings, nor have they been large enough to produce results of sufficient precision and certainty to inform policy. There is stronger evidence that multidimensional assessment can prevent falls but the size of the benefit for serious falls is quite small. The UK health policy of regular assessment of people aged 75 years and above to be carried out in general practice has been implemented haphazardly with little guidance on appropriate methods and levels of assessment. A large randomised trial is currently underway in the UK which will provide evidence on the cost effectiveness of a range of different strategies for assessment.  (+info)

Socio-economic consequences of rheumatoid arthritis in the first years of the disease. (23/5627)

OBJECTIVE: Few data have been presented to document the impact of rheumatoid arthritis (RA) on socio-economic well-being. In this study, exact figures on socio-economic consequences were assessed. METHODS: The socio-economic consequences were studied in an inception cohort (186 early RA patients, mean disease duration 3 yr) by measuring the change in work capability, income, rest during the daytime, leisure time activity, transport mobility, housing and social support occurring in the first years of the disease. RESULTS: For 89% of the patients, RA had an impact on one of the socio-economic items; for 58%, at least three of these items were affected simultaneously. Work disability appeared to be 4-15 times higher than in the general population. After 3 yr, 42% of the patients were registered as work disabled. Nearly a quarter of the patients experienced income reduction. Over 40% of the patients claimed extra rest during the daytime. Leisure activity changed towards activities with a lower joint load. There was a decline in transport mobility for 52% of the patients. Social support increased strongly. CONCLUSIONS: Socio-economic change already presents in the first years of RA and appears to be influenced by age, gender, marital status and work disability. Furthermore, physical limitation appeared to be predictive for work-related income reduction, reduced transport mobility and development of social dependency.  (+info)

Psychosocial and educational services for female college students with genital human papillomavirus infection. (24/5627)

CONTEXT: College-age women have a high risk of acquiring human papillomavirus (HPV) infection, which may have substantial psychosocial and physical effects. Young women who become infected need information and support from health care professionals, but little is known about providers' attitudes toward or provision of interventions for helping women cope with HPV. METHODS: A survey of 73 nurse practitioners and 70 physicians in college-based health clinics explored their perceptions of the need for psychosocial and educational interventions and their practices regarding such services for HPV patients. Analysis of variance and chi-square testing were used to examine differences by providers' type and gender. RESULTS: At least 86% of providers agree that HPV infection has a variety of psychosocial effects on young women, but only 54% spend at least 10 minutes providing education and counseling to all of their HPV patients. Roughly 80-90% routinely take a sexual history, explain the potential of HPV recurrence and discuss the risk of cancer with HPV patients; however, fewer than half always offer a variety of other interventions that could help patients cope with the diagnosis and promote preventive behaviors. Female providers are more aware of the psychosocial impact of HPV and the need for support than are male providers. However, nurse practitioners provide counseling and educational interventions more frequently than do physicians, even when gender is controlled for. CONCLUSIONS: College-based health providers need to improve the content of the counseling and education they offer to women with HPV, as well as the consistency with which they deliver those interventions. When they are unable to provide services, they should be able to refer patients elsewhere.  (+info)