Is exposure to chronic stressors a risk factor for Type 2 diabetes?

Background - Current policy around Type 2 diabetes (T2D) interventions to reduce rates largely invokes a bio-behavioural model. This approach is also reflected in the research literature where most research that attempts to predict the development of diabetes is restricted to conventional clinical risk factors. However, a few researchers are now suggesting that psychosocial factors (PSF), acting via the physiologic stress response (PSR) systems, increases the risk of developing diabetes. Cardiovascular disease (CVD) has been causally linked with psychosocial risk factors such as socioeconomic status, control, stress and hostility. And, while T2D and CVD share many common risk factors, the role that psychosocial factors may play is unclear, because the necessary research or analysis has not been conducted or the results interpreted from this perspective. Our working hypothesis is that the underlying mechanism is chronic activation of the PSR. Methods - The project is a comprehensive review of the literature focused on prospective studies that investigated the risk for developing diabetes. Thematic analysis of the identified resulted in 4 categories for presentation of the results: 1) subjective & objective exposure to stressors; 2) mental health; 3) aggressive behaviour & conflict with others; 4) position in the status hierarchy. Results - Even after controlling for conventional risk factors, an increased risk forT2D is seen in people: exposed to stressful working conditions or traumatic life events; with depression; with personality traits or mental health problems that put them in conflict with others (such as those with Type A personality or schizophrenia); of low SES either currently or in childhood; and in minority populations independent of current SES. The review also highlighted an almost complete lack of attention paid to non-biobehavioural factors; i.e., all risk was attributed to people behaving badly rather than the social circumstances in which they lived. Conclusions - We suggest that diabetes prevention would be more effective if 1) PSF, and in particular the problem of social disparities, were recognised and 2) intervention programmes targeted the reduction in social disparities as part of a comprehensive approach to reducing the incidence of diabetes. Message 1 - Diabetes prevention would be effective if the role of psychosocial factors were recognised. Message 2 - Intervention programmes should target a reduction in social disparities as part of a comprehensive approach to reducing the incidence of diabetes.</p

Stress and type 2 diabetes: a review of how stress contribute to the development of type 2 diabetes

Current policy and research around type 2 diabetes (T2D) interventions largely invoke a behavioral model. We suggest that activation of the physiologic stress response (PSR) from chronic exposure to stressors, low socioeconomic status (SES), severe mental health problems, or aggressive behavior increases the risk of T2D. This article is a comprehensive review of the literature on the link between T2D and psychosocial factors focusing on prospective studies of the risk for developing diabetes. The review found an increased risk for T2D in people: exposed to stressful working conditions or traumatic events; with depression; with personality traits or mental health problems that put them in conflict with others; of low SES, either currently or in childhood; and in racial/ethnic minority populations, independent of current SES. This review suggests that T2D prevention research would be more effective if (a) the PSR to psychosocial factors (especially social disparities) was recognized and (b) intervention programs evaluated reduction in social disparities as part of a comprehensive approach. Keywords : physiologic stress response, socioeconomic status, health inequalities, prospective studies</p

Changing hearts and minds: examining student nurses' experiences and perceptions of a general practice placement through a 'community of practice' lens

The recent UK Government paper 'Five year forward view' describes the need to move much patient management from secondary to primary care, and this will require a significant increase in the numbers of General Practice Nurses (GPNs). Until recently, there has been no clear recruitment strategy to address this. There have however been a number of proposed solutions to address the impending GPN recruitment crisis and to increase the numbers of new GPNs in post. General Practitioners (GPs) working in the Advanced Training Practice Scheme (ATPS) have been commissioned by Health Education England to provide placements for student nurses. This paper reports upon the findings of a study evaluating the South Yorkshire ATPS network in relation to nursing students' perceptions of general practice as a placement and a potential career option post-graduation. Data were collected using semi-structured interviews with 18 nursing students. Qualitative data analysis used a framework approach and themes were cross-checked within the team. The research had ethical approval and anonymity and confidentiality were maintained throughout. Using the Communities of Practice (CoP) framework as a theoretical lens, two main themes emerged from the data: 'Myths and misunderstandings' outlined some of the misconceptions that abounded in the absence of an established CoP in general practice. These included perceptions of what constitutes a 'good' placement, an apparent lack of relevant content in the curriculum, and the widespread use of social media by students as a means of information gathering. 'Changing hearts and minds' referred to the need to positively influence the culture within general practice by addressing some of the longstanding myths. Through the fledgling CoP, the students' perceptions of the GPN role in particular were positively revised, as was the prospect of a career in general practice upon graduation. The CoP that is emerging through the ATPS placements appear to be gradually changing the socio-cultural landscape within general practice by enabling student nurses to experience the reality of life in general practice nursing, and to view the GPN role as a viable career option upon graduation

Evidence of gender bias in True-False-Abstain medical examinations

Background: There is evidence that males and females differ in their attainment on a variety of assessments in general and in medical education. It has been suggested that the True-False-Abstain (TFA) format with negative marking is biased against females. Methods: Eight years worth of examination data from the first two years of an undergraduate medical curriculum was analysed. 359 courses were evaluated for statistically significant differences between the genders using ANOVA. Logistic regression was used to test if subject area, calendar year or exam format predicted that males or females do better (termed male advantage or female advantage). Results: Statistically significant differences between the genders were found in 111 (31%) of assessments with females doing better than males in 85 and males better in 26. Female advantage was associated with a particular year (2001), the Personal and Professional Development strand of the curriculum, in course assessment and short answer questions. Male advantage was associated with the anatomy and physiology strand of the curriculum and examinations containing TFA formats, where the largest gender difference was noted. Males were 16.7 times more likely than females to do better on an assessment if it contained any questions using the TFA format. Conclusions: Although a range of statistically significant gender differences was found, they were concentrated in TFA and short answer formats. The largest effect was for TFA formats where males were much more likely to do better than females. The gender bias of TFA assessments in medical education is yet another reason why caution should be exercised in their use.</p

Student nurses' career intentions following placements in general practice through the advanced training practices scheme (ATPS): findings from an online survey.

BACKGROUND: The demand for General Practice services in the UK, and elsewhere, is rising quickly. In part, the increasing demand is from an aging population that requires management of multiple long-term conditions. The General Practice Nurse is increasingly taking on the role. It is acknowledged that if general practice is to be able to recruit sufficient General Practice Nurses (GPNs) to meet this increasing demand in the future, new graduate nurses must be encouraged to consider general practice as a viable career option. This research is part of a review of the Advanced Training Practice Scheme (ATPS) which supported clinical placements in participating general practices. METHODS: The aim of the study was to examine nursing students' perceptions of GP placements, and their effect upon career intentions following graduation from Sheffield Hallam University (SHU), in the UK. Interviews and an online survey were used collect data. Only the survey is reported here. The bespoke survey examined students' views of: opportunities for learning new clinical skills and consolidating existing clinical skills; the learning environment in general practice and their views on a career in general practice. RESULTS: One thousand one hundred twenty undergraduate adult-field nursing students were contacted, with a response rate of 41% (N = 462). Ninety respondents had a placement and, 92% (N = 84) viewed practice nursing positively, and 77% (N = 70) felt that the placement had transformed their views on general practice. The opportunity to participate in the management of the various aspects of chronic disease was identified by 84% (N = 76) of the students as a key new skill they had acquired. They also reported that they valued a team ethos, control over aspects of work, and the variety of health problems they encountered. CONCLUSION: The findings from this study demonstrate a positive experience arising from the provision of General Practice placements for nursing students. The use of 'targeted' placement schemes with appropriate support such as this may be seen as a viable way of exposing nursing students to General Practice nursing, and of encouraging new graduate nurses to consider General Practice nursing as a viable career option

Evaluation of a new mental health liaison team in a general hospital. Part 2: exploring the themes and their effect on practice

Hospitals and emergency departments (EDs) are caring for increasing numbers of patients who present with underlying mental health issues. Managing these patients can be challenging for clinical staff who often lack the specialist knowledge and skills required to provide appropriate care. This article, the second of a two-part series on the evaluation of a newly formed mental health liaison team (MHLT) working in a general hospital, explores three themes derived from the interview data. It also considers the effect of these themes on practice, and the relationship between MHLT members and staff in EDs and the wider hospital

Who attends out-of-hours general practice appointments? Analysis of a patient cohort accessing new out-of-hours units

Objectives This report describes the patients who used additional out-of-hours (OOH) appointments offered through a UK scheme intended to increase patient access to primary care by extending OOH provision. Design Cohort study and survey data. Setting OOH appointments offered in four units in one region in England (October 2015 to November 2016). Methods Unidentifiable data on all patients were abstracted from a bespoke appointment system and the responses to a patient opinion questionnaire about this service. Descriptive analysis of the appointment data was conducted. Multivariate analysis of the opinion survey data examined the characteristics of the patients who would have gone to the emergency department (ED) had the OOH appointments not been available. Results There were 24 448 appointments for 19 701 different patients resulting in 29 629 service outcomes. Women dominated the uptake and patients from the poorest fifth of the population used nearly 40% of appointments. The patient survey found OOH appointments were extremely popular—93% selecting ‘extremely likely’ or ‘likely’ to recommend the service. Multivariate analysis of patient opinion survey data on whether ED would have been an alternative to the OOH service found that men, young children, people of Asian heritage and the most deprived were more likely to have gone to ED without this service. Conclusions The users of the OOH service were substantially different from in-hours service users with a large proportion of children under age 5, and the poor, which support the idea that there may be unmet need as the poor have the least flexible working conditions. These results demonstrate the need for equality impact assessment in planning service improvements associated with policy implementation. It suggests that OOH need to take account of patients expectations about convenience of appointments and how patients use services for urgent care needs

Connecting workspace and health : a case study

The purpose of this paper is to explore the influence of the physical workspace and work health on workplace connectivity (level and type of interactions). It summarises the first stage of research being undertaken by an interdisciplinary team of researchers on a university engineering research department that is relocating into temporary office accommodation. The research incorporates the measurement of spatial and social connectivity, as well as work health on two occasions: prior to the relocation from traditional cellular office accommodation and following the relocation into an open plan workspace. On completion of both stages, comparisons will be made to assess for changes that could be attributed to the change in workspace. The measurements taken before the move to temporary accommodation showed a limited level of physical connectivity in the traditional cellular office space. There were a number of individuals in the research department that had a much greater level of social connectivity but no pattern emerged in terms of their physical location in the workspace. However a pattern did emerge with regard to work health and social connectivity, where those with a high level of connectivity also had a high level of work stress. The practical implications of the research are to demonstrate a methodology for assessing social connectivity with workspace and health that can be applied to other organisations. It makes a contribution to the fields of work psychology, facilities management and environmental psychology that has not before considered spatiality and social connectivity with work health.</p