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1.
BMJ Open Respir Res ; 1(1): e000051, 2014.
Article in English | MEDLINE | ID: mdl-25478193

ABSTRACT

BACKGROUND: Pulmonary Rehabilitation (PR) is an important treatment for patients with chronic obstructive pulmonary disease (COPD) but it is not established whether any baseline parameter can predict response or compliance. AIM: To identify whether baseline measures can predict who will complete the programme and who will achieve a clinically significant benefit from a Minimum Clinical Important Difference (MCID) in terms of exercise capacity and health-related quality of life (HRQoL). METHODS: Data were collected prospectively from patients with COPD at their baseline assessment for an outpatient PR programme in one of eight centres across London. 'Completion' was defined as attending at least 75% of the designated PR visits and return for the follow-up evaluation. The MCID for outcome measures was based on published data. RESULTS: 787 outpatients with COPD (68.1±10.5 years old; 49.6% males) were included. Patients who completed PR (n=449, 57.1%) were significantly older with less severe airflow obstruction, lower anxiety and depression scores, less dyspnoea and better HRQoL. Only baseline CAT score (OR=0.925; 95% CI 0.879 to 0.974; p=0.003) was retained in multivariate analysis. Patients with the lowest baseline walking distance were most likely to achieve the MCID for exercise capacity. No baseline variable could independently predict achievement of an MCID in HRQoL. CONCLUSIONS: Patients with better HRQoL are more likely to complete PR while worse baseline exercise performance makes the achievement of a positive MCID in exercise capacity more likely. However, no baseline parameter could predict who would benefit the most in terms of HRQoL.

2.
Thorax ; 66(5): 425-9, 2011 May.
Article in English | MEDLINE | ID: mdl-21398686

ABSTRACT

BACKGROUND: The COPD (chronic obstructive pulmonary disease) assessment test (CAT) is a recently introduced, simple to use patient-completed quality of life instrument that contains eight questions covering the impact of symptoms in COPD. It is not known how the CAT score performs in the context of clinical pulmonary rehabilitation (PR) programmes or what the minimum clinically important difference is. METHODS: The introduction of the CAT score as an outcome measure was prospectively studied by PR programmes across London. It was used alongside other measures including the St George's Respiratory Questionnaire, the Chronic Respiratory Disease Questionnaire, the Clinical COPD Questionnaire, the Hospital Anxiety and Depression score, the Medical Research Council (MRC) dyspnoea score and a range of different walking tests. Patients completed a 5-point anchor question used to assess overall response to PR from 'I feel much better' to 'I feel much worse'. RESULTS: Data were available for 261 patients with COPD participating in seven programmes: mean (SD) age 69.0 (9.0) years, forced expiratory volume in 1 s (FEV(1)) 51.1 (18.7) % predicted, MRC score 3.2 (1.0). Mean change in CAT score after PR was 2.9 (5.6) points, improving by 3.8 (6.1) points in those scoring 'much better' (n=162), and by 1.3(4.5) in those who felt 'a little better' (n=88) (p=0.002). Only eight individuals reported no difference after PR and three reported feeling 'a little worse', so comparison with these smaller groups was not possible. CONCLUSION: The CAT score is simple to implement as an outcome measure, it improves in response to PR and can distinguish categories of response.


Subject(s)
Pulmonary Disease, Chronic Obstructive/rehabilitation , Severity of Illness Index , Aged , Female , Forced Expiratory Volume/physiology , Humans , Male , Middle Aged , Prospective Studies , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/physiopathology , Quality of Life , Treatment Outcome
3.
Int J Aging Hum Dev ; 69(2): 133-58, 2009.
Article in English | MEDLINE | ID: mdl-19960863

ABSTRACT

This article examines experiences of chronological age. Using data from the British Household Panel Survey, we analyze both qualitatively and quantitatively verbatim responses from 8177 respondents aged 16 and over concerning the (dis)advantages of their age. Two main questions are tested: 1) Is the cultural narrative of age decline supported by the experiences of our respondents? 2) Are age experiences differentiated by gender? We find people's age experiences are multidimensional and multidirectional, incorporating narratives of progress and decline. Our data show marked gender differences in age experiences, but give little support to claims of a double standard concerning the aging body. More generally, we find that people contrast current experiences with their younger and older selves. We argue that future conceptual developments need to take seriously both a synchronic and diachronic understanding of age, highlighting not just the present but also the distinctive historical development of individuals across time.


Subject(s)
Activities of Daily Living/psychology , Aging/psychology , Life Style , Self-Assessment , Surveys and Questionnaires , Adolescent , Adult , Age Distribution , Aged , Aged, 80 and over , Female , Follow-Up Studies , Humans , Male , Middle Aged , Personal Autonomy , Retrospective Studies , Sex Distribution , Socioeconomic Factors , United Kingdom , Young Adult
4.
J Interpers Violence ; 21(7): 869-89, 2006 Jul.
Article in English | MEDLINE | ID: mdl-16731989

ABSTRACT

Infants aged younger than 12 months have the highest homicide victimization rate of any single age group in England and Wales. In addition, there are good grounds for believing that the official homicide statistics for this particular age group are an underestimate and subject to distortion. At the same time there is evidence mounting in the United Kingdom that some parents have been incorrectly convicted of infanticide. This article first explores all recorded cases of infanticide in England and Wales for the period 1995-2002 (298 cases in total). Characteristics of the offenders, victims, offense, and court outcomes are examined. The second part of the article takes a critical gaze at the complexities involved in distinguishing infanticide from sudden infant death syndrome (SIDS) and other sudden unexplained deaths in infancy (SUDI). The article ends by considering in what ways infant deaths might be more effectively investigated.


Subject(s)
Child Abuse/diagnosis , Child Abuse/statistics & numerical data , Death Certificates , Infanticide/statistics & numerical data , Adult , Cause of Death , Child Abuse/legislation & jurisprudence , Criminal Law/legislation & jurisprudence , England/epidemiology , Female , Humans , Infant , Infant, Newborn , Infanticide/legislation & jurisprudence , Male , Retrospective Studies , Socioeconomic Factors , Sudden Infant Death/epidemiology , Wales/epidemiology
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