A qualitative study of GPs' views towards obesity : are they fighting or giving up?

Objectives: Several studies indicate that general practitioners (GPs) are not taking the issue of obesity as seriously as they should. Therefore, the aim of this study was to understand GPs' views about obesity and obese people and how these professionals perceive their role in the treatment of this disease. Study design: Qualitative study using semi-structured interviews. Methods: Sixteen semi-structured interviews were conducted with Portuguese GPs. Data were analyzed according to thematic analysis procedures. Results: GPs are negative about their own role in obesity treatment. Although they believe it is part of their job to advise obese patients on the health risks of obesity, the majority of doctors think they are not making any difference in getting their patients to make long term lifestyle changes. GPs hold negative attitudes towards these patients blaming them for being unmotivated and non-compliant and are also pessimistic about their ability to lose weight. Doctors are facing a dilemma in their practices: they want to play an active role but, due to a set of negative beliefs and perceived barriers, they are playing a relatively passive role, feeling defeated and unmotivated, which is reflected in a decrease of efforts and a willing to give up on most of the cases. Conclusions: This issue should be taken in to account during physicians' education since doctors should be aware of how their own beliefs and attitudes influence their behaviour and practices, compromising, therefore, the adherence to and the success in obesity treatment. They seem to need more precise guidelines and better tools for screening and management of obesity, more referral options, and improved coordination with other specialitie

Die amerikanische Staats-Domäne (National Park) im Quellgebiete des Yellowstone Flusses mit den Geyser-Gebieten.

"Petermann's Geographische Mittheilungen, Jahrgang 1872, Tafel 13".Insets.National Park Exhibit, 1972. DL

Ground Water Dependence of Endangered Ecosystems: Nebraska’s Eastern Saline Wetlands

Many endangered or threatened ecosystems depend on ground water for their survival. Nebraska’s saline wetlands, home to a number of endangered species, are ecosystems whose development, sustenance, and survival depend on saline ground water discharge at the surface. This study demonstrates that the saline conditions present within the eastern Nebraska saline wetlands result from the upwelling of saline ground water from within the underlying Dakota Aquifer and deeper underlying formations of Pennsylvanian age. Over thousands to tens of thousands of years, saline ground water has migrated over regional scale flowpaths from recharge zones in the west to the present-day discharge zones along the saline streams of Rock, Little Salt, and Salt creeks in Lancaster and Saunders counties. An endangered endemic species of tiger beetle living within the wetlands has evolved under a unique set of hydrologic conditions, is intolerant to recent anthropogenic changes in hydrology and salinity, and is therefore on the brink of extinction. As a result, the fragility of such systems demands an even greater understanding of the interrelationships among geology, hydrology, water chemistry, and biology than in less imperiled systems where adaptation is more likely. Results further indicate that when dealing with ground water discharge–dependent ecosystems, and particularly those dependent on dissolved constituents as well as the water, wetland management must be expanded outside of the immediate surface location of the visible ecosystem to include areas where recharge and lateral water movement might play a vital role in wetland hydrologic and chemical mixing dynamics