Can general practitioners influence the nation's health through a population approach to the provision of lifestyle advice?

BACKGROUND: Lifestyle advice from general practitioners (GPs) has been shown to have a positive effect on population health. In practice, GPs provide lifestyle advice to a minority of their patients only, those who are high risk or already have symptoms. AIM: To look in depth at GPs' attitudes towards adopting a population approach to lifestyle advice and to use these results to identify ways of maximising the potential of GPs to affect population health. METHOD: Thirty-six GPs, purposively sampled by identifying characteristics likely to affect their health promotion activity, participated in a focus group study. Data from the focus groups were transcribed verbatim and analysed using standard methods. RESULTS: The main themes that emerged suggested that GPs do not take a population approach to lifestyle advice because they prefer a high risk approach and doubt their ability to be effective in a population approach. GPs believed that social, cultural, and environmental factors were the most important determinants of population health. Furthermore, they were concerned about the detrimental effects on the doctor-patient relationship of providing lifestyle advice to all patients. GPs believed that a multi-agency, centrally co-ordinated approach was the preferred way to improve population health and that their role should be limited to secondary prevention. CONCLUSION: Large amounts of resources would be necessary to convince GPs to adopt a population approach to lifestyle advice. Measures to tackle the social and environmental determinants of health may be a more effective and efficient means of improving the nation's health

Increasing population levels of physical activity through primary care: GPs' knowledge, attitudes and self-reported practice

Background. GPs have the potential to increase population levels of activity and thus produce important health gains. Objectives and methods. The aim of this questionnaire survey was to determine the knowledge, attitudes and self-reported practice of GPs towards promoting regular physical activity and to assess the likely impact of GPs on population levels of physical activity. Results and conclusions. A high response rate to the questionnaire was obtained and the results suggest that GPs have a good level of knowledge of the health benefits of regular physical activity and the levels required to achieve these, but do not promote activity in a way that will have an impact on the population level. Keywords. General practice, health promotion, physical activity, population approach

What Works? A Study of Effective Early Childhood Mental Health Consultation Programs

Examines factors that lead to desirable outcomes in mental health consultation programs: solid program infrastructure, highly qualified consultants, and quality support services. Analyzes targeted outcomes, measurements, and intensity of interventions

Impact of Small Group Size on Neighborhood Influences in Multilevel Models

Objective: Although there is a growing body of literature on sample size in multilevel or hierarchical modeling, few studies have examined the impact of group sizeMultilevel, Neighborhood, Body Weight, Obesity, Sample Size

Life after stroke: ‘a life I like’ and ‘a life to live’.

This doctoral thesis describes, critically evaluates and reflects on the development and evaluation of an innovative approach to supporting individuals after a stroke. This approach consists of; a once-weekly, twelve week, stroke self-management programme consisting of interactive information provision, rehabilitation and exercise in an environment of peer and caregiver support called ‘ASPIRE’ – an acronym for Acute stroke, Self-management support, secondary Prevention, Information, Rehabilitation and Exercise. The development of the ASPIRE programme was influenced by interviews with those involved in the ASPIRE programme and the process and results of a primary research evaluation using mixed methods. The aim of this two phase evaluation was to 1) identify participants’ views as to the outcomes of attending the ASPIRE programme, using a grounded theory approach and 2) identify whether those outcomes could be assessed using currently existing standardised validated tools. Three key themes were identified; A life I like – the confidence to do the everyday activities important to a person after a stroke; Changing hearts and minds – the confidence, knowledge and health behaviour change to reduce vascular risk after stroke and In the same boat – the benefits of peer support for stroke survivors and caregivers. These themes were used to select relevant standardised validated tools; the Stroke Knowledge Test (SKT), Stroke Self Efficacy Questionnaire (SSEQ), Cerebrovascular Attitudes and Beliefs Scale (CABS-R), Hospital Anxiety and Depression Scale (HADS) and Caregiver Strain Index (CSI). Statistically significant gains were identified in the SKT and HADS – depression score. The tools were useful and sensitive to change; however, the SSEQ had a ceiling effect with this cohort and the CABS-R was found difficult to use. Although existing outcome tools may not adequately measure new multi-factorial post-stroke interventions such as the ASPIRE programme, the unique contributions of this doctoral thesis to the body of knowledge are that; • An enabling culture, that includes peer support for stroke survivors and caregivers, helps individuals to move forward after stroke. • Support for self-generated goal planning, based on a ‘life-thread’ approach, may improve outcomes from stroke survivors’ perspectives. • Supporting individuals to develop the confidence, knowledge and health behaviours to reduce vascular risk can be an integral and complementary part of rehabilitation after stroke. A multi-factorial programme to enable life after stroke should therefore include both rehabilitation “A life I like” and secondary prevention “A life to live”. • Individually tailored exercise programmes to support rehabilitation and secondary prevention can be used with groups of stroke survivors with a wide range of deficits

Gratitude to God, Self‐Rated Health, and Depressive Symptoms

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/107511/1/jssr12110.pd

Developing Faculty to Provide University Students With Improved Learning Experiences

The article addresses the importance of incorporating faculty development as a key priority of higher education institutions. A literature review and some face-to-face and online interviews were conducted at various U.S. institutions, to identify common and best practices regarding this important matter. The article offers some ideas about what is done, and how it is done, to help faculty be ready for the challenging role they need to play: to be effective developers of a diverse student body that meets the evolving needs of industry and that utilizes technological tools that never existed before

Arterial stiffness and wave reflection 1 year after a pregnancy complicated by hypertension.

Hypertensive disorders of pregnancy (HDP) are associated with cardiovascular disease (CVD) later in life. The authors investigated the association of HDP with blood pressure (BP) and arterial stiffness 1-year postpartum. Seventy-four participants, 33 with an HDP and 41 with uncomplicated pregnancies, were examined using applanation tonometry to measure BP, carotid-femoral pulse wave velocity (cfPWV), and augmentation index (AIx). On average, women with HDP had a 9 mm higher systolic BP (

Editorial overview of Pearls Microbiome Series: E pluribus unum

The human microbiome constitutes the collection of all the microorganisms living in association with the human body with each body site being home to a unique microbial community. Human-associated microbial communities can include eukaryotes, archaea, bacteria, and viruses and provide protection against foreign invaders, stimulate the immune response, produce antimicrobials, and aid in digestion among other functions. Our understanding of the link between the human microbiome and disease is rapidly expanding in large part due to revolutionizing advances in next generation sequencing. In fact, an ever-growing number of studies have demonstrated that changes in the composition of our microbiomes correlate with numerous disease states or responses to treatment. However, understanding the impact of shifts in microbial communities on health and disease and the mechanisms that confer stability in the microbiome have been challenging to elucidate, due to the vast microbial diversity and differences between individuals. Nevertheless, the notion that manipulation of microbial communities may provide prophylactic or therapeutic tools to improve human health has been the focus of much research. Here, we highlight a collection of Pearls articles delving into the current state of knowledge linking the microbiome to human disease

The availability, appropriateness, and integration of services to promote Indigenous Australian youth wellbeing and mental health : Indigenous youth and service provider perspectives

Concerns about the complexity, fragmentation and inefficiency of Australia’s current youth mental health service systems have led policy makers to seek improvements through a shift to community-based solutions. However, there is little evidence of how communities can make this shift. This paper examines the efforts of one Aboriginal and Torres Strait Islander (hereafter, respectfully, Indigenous) community—Yarrabah in north Queensland—to develop strategies for mental health and wellbeing service system improvements for school-aged youth (5–18 years). The research was co-designed with Yarrabah’s community-controlled health service and explores the perceptions of Yarrabah youth and service providers. Iterative grounded theory methods were used to collect and analyse data from 32 youth aged 11–24 years and 24 service providers. Youth were reluctant to seek help, and did so only if they felt a sense of safety, trust, relationality and consistency with providers. Young people’s four suggestions for improvement were access to (1) information and awareness about mental health; (2) youth facilities, spaces and activities; (3) safe and available points of contact; and (4) support for recovery from mental illness. Service providers highlighted an appetite for youth-guided community change and recommended five improvement strategies: (1) listening to youth, (2) linking with community members, (3) providing wellbeing promotion programs, (4) intervening early, and (5) advocating to address the determinants of youth mental health. Overall, both groups realised a disjunct between youth need and service provision, but a willingness to work together for systems change. This study demonstrates the importance of community-driven efforts that harness both youth and service providers’ perspectives, and suggests a need for ongoing dialogue as the basis for co-designing and implementing improvements to wellbeing supports and mental health services for Indigenous youth