Improving the health of people with multimorbidity: the need for prospective cohort studies

The dramatic rise in long-term conditions (LTCs) represents a major challenge for individuals, families, and health care systems worldwide. Due to the scale of this rise, the management of patients with LTCs largely falls within the domain of primary rather than secondary care, at least in countries with well-developed primary care systems. For example, in the UK, which has a comprehensive primary care system based around general practice (trained family physicians working in multidisciplinary teams) and funded by the National Health Service (NHS), primary care contacts account for around 90% of the total activity of the NHS, and patients with LTCs account for 80% of general practice consultations. Effective primary care and community-based management of people with LTCs is thus a top priority

Accentuate the negative

A survey of mean inequalities with real weights is given.Comment: 16 pages 3 figure

Laser interferometric measurement of ion electrode shape and charge exchange erosion

A projected fringe profilometry system was applied to surface contour measurements of an accelerator electrode from an ion thrustor. The system permitted noncontact, nondestructive evaluation of the fine and gross structure of the electrode. A 3-D surface map of a dished electrode was generated without altering the electrode surface. The same system was used to examine charge exchange erosion pits near the periphery of the electrode to determine the depth, location, and volume of material lost. This electro-optical measurement system allowed rapid, nondestructive, digital data acquisition coupled with automated computer data processing. In addition, variable sensitivity allowed both coarse and fine measurements of objects having various surface finishes

Patient enablement requires physician empathy: a cross-sectional study of general practice consultations in areas of high and low socioeconomic deprivation in Scotland

<b>Background</b> Patient 'enablement' is a term closely aligned with 'empowerment' and its measurement in a general practice consultation has been operationalised in the widely used patient enablement instrument (PEI), a patient-rated measure of consultation outcome. However, there is limited knowledge regarding the factors that influence enablement, particularly the effect of socio-economic deprivation. The aim of the study is to assess the factors influencing patient enablement in GP consultations in areas of high and low deprivation.<p></p> <b>Methods</b> A questionnaire study was carried out on 3,044 patients attending 26 GPs (16 in areas of high socio-economic deprivation and 10 in low deprivation areas, in the west of Scotland). Patient expectation (confidence that the doctor would be able to help) was recorded prior to the consultation. PEI, GP empathy (measured by the CARE Measure), and a range of other measures and variables were recorded after the consultation. Data analysis employed multi-level modelling and multivariate analyses with the PEI as the dependant variable.<p></p> <b>Results</b> Although numerous variables showed a univariate association with patient enablement, only four factors were independently predictive after multilevel multivariate analysis; patients with multimorbidity of 3 or more long-term conditions (reflecting poor chronic general health), and those consulting about a long-standing problem had reduced enablement scores in both affluent and deprived areas. In deprived areas, emotional distress (GHQ-caseness) had an additional negative effect on enablement. Perceived GP empathy had a positive effect on enablement in both affluent and deprived areas. Maximal patient enablement was never found with low empathy.<p></p> <b>Conclusions</b> Although other factors influence patient enablement, the patients' perceptions of the doctors' empathy is of key importance in patient enablement in general practice consultations in both high and low deprivation settings

Hypothalamic gene expression during voluntary hypophagia in the Sprague-Dawley rat on withdrawal of the palatable liquid diet, Ensure

Copyright © 2014 Elsevier Inc. All rights reserved.Peer reviewedPostprin

Double trouble: the impact of multimorbidity and deprivation on preference-weighted health related quality of life - a cross sectional analysis of the Scottish Health Survey

<b>Objective</b> To investigate the association between multimorbidity and Preference_Weighted Health Related Quality of Life (PW_HRQoL), a score that combines physical and mental functioning, and how this varies by socioeconomic deprivation and age.<p></p> <b>Design</b> The Scottish Health Survey (SHeS) is a cross-sectional representative survey of the general population which included the SF-12, a survey of HRQoL, for individuals 20 years and over.<p></p> <b>Methods</b> For 7,054 participants we generated PW_HRQoL scores by running SF-12 responses through the SF-6D algorithm. The resulting scores ranged from 0.29 (worst health) to 1 (perfect health). Using ordinary least squares, we first investigated associations between scores and increasing counts of longstanding conditions, and then repeated for multimorbidity (2+ conditions). Estimates were made for the general population and quintiles of socioeconomic deprivation. For multimorbidity, the analyses were repeated stratifying the population by age group (20--44, 45--64, 65+).<p></p> <b>Results</b> 45% of participants reported a longstanding condition and 18% reported multimorbidity. The presence of 1, 2, or 3+ longstanding conditions were associated with average reductions in PW_HRQoL scores of 0.081, 0.151 and 0.212 respectively. Reduction in scores associated with multimorbidity was 33% greater in the most deprived quintile compared to the least deprived quintile, with the biggest difference (80%) in the 20--44 age groups. There were no significant gender differences.<p></p> <b>Conclusions</b> PW_HRQoL decreases markedly with multimorbidity, and is exacerbated by higher deprivation and younger age. There is a need to prioritise interventions to improve the HRQoL for (especially younger) adults with multimorbidity in deprived areas

The development of direct payments in the UK: implications for social justice

Direct payments have been heralded by the disability movement as an important means to achieving independent living and hence greater social justice for disabled people through enhanced recognition as well as financial redistribution. Drawing on data from the ESRC funded project Disabled People and Direct Payments: A UK Comparative Perspective, this paper presents an analysis of policy and official statistics on use of direct payments across the UK. It is argued that the potential of direct payments has only partly been realised as a result of very low and uneven uptake within and between different parts of the UK. This is accounted for in part by resistance from some Labour-controlled local authorities, which regard direct payments as a threat to public sector jobs. In addition, access to direct payments has been uneven across impairment groups. However, from a very low base there has been a rapid expansion in the use of direct payments over the past three years. The extent to which direct payments are able to facilitate the ultimate goal of independent living for disabled people requires careful monitoring

Using normalisation process theory to understand barriers and facilitators to implementing mindfulness-based stress reduction for people with multiple sclerosis

Objectives: To study barriers and facilitators to implementation of mindfulness-based stress reduction for people with multiple sclerosis. Methods: Qualitative interviews were used to explore barriers and facilitators to implementation of mindfulness-based stress reduction, including 33 people with multiple sclerosis, 6 multiple sclerosis clinicians and 2 course instructors. Normalisation process theory provided the underpinning conceptual framework. Data were analysed deductively using normalisation process theory constructs (coherence, cognitive participation, collective action and reflexive monitoring). Results: Key barriers included mismatched stakeholder expectations, lack of knowledge about mindfulness-based stress reduction, high levels of comorbidity and disability and skepticism about embedding mindfulness-based stress reduction in routine multiple sclerosis care. Facilitators to implementation included introducing a pre-course orientation session; adaptations to mindfulness-based stress reduction to accommodate comorbidity and disability and participants suggested smaller, shorter classes, shortened practices, exclusion of mindful-walking and more time with peers. Post-mindfulness-based stress reduction booster sessions may be required, and objective and subjective reports of benefit would increase clinician confidence in mindfulness-based stress reduction. Discussion: Multiple sclerosis patients and clinicians know little about mindfulness-based stress reduction. Mismatched expectations are a barrier to participation, as is rigid application of mindfulness-based stress reduction in the context of disability. Course adaptations in response to patient needs would facilitate uptake and utilisation. Rendering access to mindfulness-based stress reduction rapid and flexible could facilitate implementation. Embedded outcome assessment is desirable

Understanding emotional and social intelligence among English language teachers

Emotions and social relationships are at the centre of all human behaviour. Teaching in particular requires the careful handling of students? and teachers? own emotions as well as the sensitive promotion of positive social relationships between the teacher and students and among students. These emotional and social competences are key components of effective classroom management and teacher competences. However, there has been surprisingly little research on how these competences function in actual classrooms and how best they can be fostered. Language teaching in particular depends on these competences given the intercultural, social and interpersonal character of communication in a foreign language. In what follows, we review the literature on emotional intelligence (EI) and social intelligence (SI) within psychology and education, and argue for the relevance and importance of both constructs specifically within English language teaching (ELT). We report on the findings of a mixed-methods empirical study on the EI and SI of English language teachers across the globe, and then examine in more detail the beliefs and practices of highly emotionally and socially intelligent teachers in the UK and Austria. We conclude the paper by reflecting on the implications of the findings for language teaching and language teacher education