The role of primary care in adult weight management: qualitative interviews with key stakeholders in weight management services

Background: Primary care has a key role to play in the prevention and management of obesity, but there remain barriers to engagement in weight management by primary care practitioners. The aim of this study was to explore the views of key stakeholders in adult weight management services on the role of primary care in adult weight management. Methods: Qualitative study involving semi-structured interviews with nine senior dietitians involved in NHS weight management from seven Scottish health boards. Transcripts were analysed using an inductive thematic approach. Results: A range of tensions were apparent within three key themes: weight management service issues, the role of primary care, and communication with primary care. For weight management services, these tensions were around funding, the management model of obesity, and how to configure access to services. For primary care, they were around what primary care should be doing, who should be doing it, and where this activity should fit within wider weight management policy. With regard to communication between weight management services and primary care, there were tensions related to the approach taken (locally adapted versus centralised), the message being communicated (weight loss versus wellbeing), and the response from practitioners (engagement versus resistance). Conclusions: Primary care can do more to support adult weight management, but this requires better engagement and communication with weight management services, to overcome the tensions highlighted in this study. This, in turn, requires more secure, sustained funding. The example of smoking cessation in the UK, where there is a network of well-resourced NHS Stop Smoking Services, accessible via different means, could be a model to follow

Patient and practice characteristics predicting attendance and completion at a specialist weight management service in the UK: a cross-sectional study

Objective: To determine the association between patient and referring practice characteristics and attendance and completion at a specialist health service weight management service (WMS). Design: Cross-sectional study. Setting: Regional specialist WMS located in the West of Scotland. Participants: 9677 adults with obesity referred between 2012 and 2014; 3250 attending service and 2252 completing. Primary and secondary outcome measures: Primary outcome measure was attendance at the WMS; secondary outcome was completion, defined as attending four or more sessions. Analysis: Multilevel binary logistic regression models constructed to determine the association between patient and practice characteristics and attendance and completion. Results: Approximately one-third of the 9677 obese adults referred attended at least one session (n=3250, 33.6%); only 2252 (23%) completed by attending four or more sessions. Practice referrals ranged from 1 to 257. Patient-level characteristics were strongest predictors of attendance; odds of attendance increased with age (OR 4.14, 95% CI 3.27 to 5.26 for adults aged 65+ compared with those aged 18–24), body mass index (BMI) category (OR 1.83, 95% CI 1.56 to 2.15 for BMI 45+ compared with BMI 30–35) and increasing affluence (OR 1.96, 95% CI 1.17 to 3.28). Practice-level characteristics most strongly associated with attendance were being a non-training practice, having a larger list size and not being located in the most deprived areas. Conclusions: There was wide variation in referral rates across general practice, suggesting that there is still much to do to improve engagement with weight management by primary care practitioners. The high attrition rate from referral to attendance and from attendance to completion suggests ongoing barriers for patients, particularly those from the most socioeconomically deprived areas. Patient and practice-level characteristics can help us understand the observed variation in attendance at specialist WMS following general practitioner (GP) referral and the underlying explanations for these differences merit further investigation

How to Summarize Estimates of Ancestral Divergence Times

The use of molecular sequence data has increased interest in trying to date evolutionary events, with researchers wanting both an estimate of the divergence time and a confidence interval for that estimate. However, two methodological issues have recently been raised with respect to precision of the estimates: (i) the time of the ancestral event is over-estimated; and (ii) the confidence interval is asymmetrical. I argue that if the estimates of divergence time are considered to be samples from a lognormal probability distribution, then this would explain both of these problems. This implies that divergence times should be presented using geometric means rather than arithmetic means, both for estimates and for their confidence intervals. I present analyses based on both computer simulations and empirical data to show that this approach is effective for both single-gene and multiple-gene data sets. Treating divergence time as a lognormal variable thus provides a simple unifying framework for dealing with many of the problems associated with the estimation of divergence (and possibly coalescence) times. Use of this approach (based on geometric means) can, unfortunately, lead to very different biological conclusions compared to the currently used calculation methods (based on arithmetic means)

The Late Prehistoric Period in the Mackenzie Valley

Artifacts from more than 20 late prehistoric components in the Mackenzie valley are described and compared with those from contemporaneous assemblages from neighbouring areas. MacNeish's Spence River phase is expanded to cover this material, which seems to exhibit at least some integrity and distinctiveness, and which appears to date from about A.D. 700 to the time of European contact. Certain technological similarities are noted with the Klo-Kut and Aishihik phases to the West and the late Taltheilei tradition to the East, but these similarities are difficult to synthesize into any meaningful outline of Canadian Athapaskan prehistory.Key words: archaeology, subarctic, Mackenzie valley, Spence River phase, Plains notched pointsMots clés: archéologie, sub-arctique, vallée du Mackenzie, phase de la rivière Spence, pointes à des Plaine