Expected values for pedometer-determined physical activity in older populations

The purpose of this review is to update expected values for pedometer-determined physical activity in free-living healthy older populations. A search of the literature published since 2001 began with a keyword (pedometer, "step counter," "step activity monitor" or "accelerometer AND steps/day") search of PubMed, Cumulative Index to Nursing & Allied Health Literature (CINAHL), SportDiscus, and PsychInfo. An iterative process was then undertaken to abstract and verify studies of pedometer-determined physical activity (captured in terms of steps taken; distance only was not accepted) in free-living adult populations described as ≥ 50 years of age (studies that included samples which spanned this threshold were not included unless they provided at least some appropriately age-stratified data) and not specifically recruited based on any chronic disease or disability. We identified 28 studies representing at least 1,343 males and 3,098 females ranging in age from 50–94 years. Eighteen (or 64%) of the studies clearly identified using a Yamax pedometer model. Monitoring frames ranged from 3 days to 1 year; the modal length of time was 7 days (17 studies, or 61%). Mean pedometer-determined physical activity ranged from 2,015 steps/day to 8,938 steps/day. In those studies reporting such data, consistent patterns emerged: males generally took more steps/day than similarly aged females, steps/day decreased across study-specific age groupings, and BMI-defined normal weight individuals took more steps/day than overweight/obese older adults. The range of 2,000–9,000 steps/day likely reflects the true variability of physical activity behaviors in older populations. More explicit patterns, for example sex- and age-specific relationships, remain to be informed by future research endeavors

Phase 1 Research Report on the IMPRESS Health 2 (Interreg IVA Channel Programme) Project 4282: Understanding the factors behind the late testing and diagnosis of HIV

This report outlines Phase 1 data from an EU Interreg IVA Channel Programme funded research project (Number 4282) conducted to understand factors behind the late testing and diagnosis of HIV in Kent and Medway (UK). The views of patients or service users (n=37) and health care professionals (n=16) on the barriers to early HIV testing and diagnosis were elicited in a series of semi-structured interviews across three organisations providing HIV testing in Kent and Medway between January and March 2014. A retrospective analysis of all patients diagnosed with HIV between January 2008 and December 2013 (n=242) in those centres was also conducted to identify the proportion of early and late presenters in each organisation and identify any correlating factors which may have impacted upon an individual's likelihood of being diagnosed late (i.e. with a CD4 count <350). Chief among the recommendations for a Phase 2 intervention study were the need for improved education and training of healthcare staff (particularly in primary care) to elicit individual's concerns about HIV risk and address stereotypical ideas that it is a condition which predominantly affects men who have sex with men or particular immigrant populations. The data showed that white heterosexuals, and in particular, white women were at particular risk of having their HIV diagnosed late in the region. The second recommendation for immediate action was the need for a concerted social media and public health campaign aimed at 'atypical' HIV patient groups in order to raise awareness of HIV transmission risk and the benefits of early testing and diagnosis

Students’ and examiners’ perception of feedback practices following OSCE in Uniport

The Objective Structured Clinical Examination (OSCE) offers several opportunities for effective feedback to be given to students to improve their performance. This study aimed to evaluate the feedback practices following OSCE in the University of Port Harcourt (Uniport). This was descriptive research involving the administration of semi-structured questionnaires to examiners in the Faculty of Clinical Sciences and final year medical students in Uniport. Information sought centred on their perception of feedback practices following OSCE. Data was analysed using descriptive statistics and Chi-square. The result showed that 114 examiners participated in the study. There were 72 (63.16%) male and 42 (36.84%) female examiners with male to female ratio of 1.7:1. Ninety students participated in the study. There were 49 (54.44%) males and 41 (45.56%) females. Their mean age was 25.42±2.36. There were significant differences between the examiners and students perception of feedback practices following OSCE in Uniport in terms of whether (P=0.009) and when (P=0.0014) it is provided. Majority of the examiners (58.49%) and almost all the students (91.49%) reported that feedback resulted in improved performance. The stud y showed that about half of the students claimed that feedback is given following OSCE in Uniport. Feedback practice following OSCE in Uniport is satisfactory in some aspects and deficient in some other aspects. Incorporate quality feedback practices into the OSCE process in all medical schools will improve skills development and learning

Do the poor cost much more? The relationship between small area income deprivation and length of stay for elective hip replacement in the English NHS from 2001 to 2008

The Blair/Brown reforms of the English NHS in the early to mid 2000s gave hospitals strong new incentives to reduce waiting times and length of stay for elective surgery. One concern was that these efficiency-oriented reforms might harm equity, by giving hospitals new incentives to select against socio-economically disadvantaged patients who stay longer and cost more to treat. This paper aims to assess the magnitude of these new selection incentives in the test case of hip replacement. Anonymous hospital records are extracted on 274,679 patients admitted to English NHS Hospital Trusts for elective total hip replacement from 2001/2 through 2007/8. The relationship between length of stay and small area income deprivation is modelled allowing for other patient characteristics (age, sex, number and type of diagnoses, procedure type) and hospital effects. After adjusting for these factors, we find that patients from the most deprived tenth of areas stayed just 6% longer than others in 2001/2, falling to 2% by 2007/8. By comparison, patients aged 85 or over stayed 57% longer than others in 2001/2, rising to 71% by 2007/8, and patients with seven or more diagnoses stayed 58% longer than others in 2001/2, rising to 73% by 2007/8. We conclude that the Blair/Brown reforms did not give NHS hospitals strong new incentives to select against socio-economically deprived hip replacement patients

Parents’ views on how health professionals should work with them now to get the best for their child in the future

Background  Pregnancy and the first years of life are important times for future child well-being. Early identification of families and children who might be likely to experience poorer outcomes could enable health professionals and parents to work together to promote each child’s well-being. Little is known about the acceptability and feasibility of such an approach to parents. Objective  To investigate parents’ views about how health professionals should identify and work with families who may benefit from additional input to maximize their children’s future health and well-being. Design  A qualitative study using focus groups. Setting and participants  Eleven focus groups were conducted with a total of 54 parents; 42 mothers and 12 fathers living in the north of England. Results  Parents welcomed the idea of preventive services. They strongly believed that everyone should have access to services to enhance child well-being whilst recognizing that some families need additional support. Making judgements about who should receive additional services based on specific criteria evoked powerful emotions because of the implication of failure. Parents projected a belief in themselves as ‘good parents’ even in adverse circumstances. Conclusions  Targeted additional preventive services can be acceptable and welcome if health professionals introduce them sensitively, in the context of an existing relationship, providing parents are active participants

Inequalities in child welfare intervention rates: the intersection of deprivation and identity: child welfare inequalities: deprivation, identity

Child welfare systems internationally exhibit very large inequalities in a variety of dimensions of practice, for example, in rates of child protection plans or registrations and out‐of‐home care. Previous research in the midlands region of England (Bywaters; Bywaters et al.) has detailed key aspects of the relationship between levels of neighbourhood deprivation and intervention rates. This paper reports further evidence from the study examining the intersection of deprivation with aspects of identity: gender, disability, ethnicity and age. Key findings include a decreasing gender gap and a decreasing proportion of children in need reported to be disabled as deprivation increases. The data challenge the perception that black children are more likely than white to be in out‐of‐home care, a finding that only holds if the much higher level of deprivation among black children is not taken into account. Similarly, after controlling for deprivation and age, Asian children were found to be up to six times less likely to be in out‐of‐home care. The study requires replication and extension in order that observed inequalities are tested and explained. Urgent ethical, research, policy and practice issues are raised about child welfare systems

Health and Society: reflections on policy

SUMMARY Improvements in health among the populations of developed countries have come about largely through improved living standards and public health measures, and the contribution of medicine has been relatively small. In addition, many medical techniques of the present have not yet been evaluated. A health policy giving due weight to broad social measures is applicable to both developed and underdeveloped countries, but this may involve change in underlying socioeconomic structures and so encounter political obstacles. RESUMEN Salud y sociedad: reflexiones sobre pol&amp;#x006b;?tica Los progresos en salud registrados en los países desarrollados, derivan principalmente de mejoramientos en los niveles de vida y de medidas de salud pública, siendo relativamente pequeña la contribución de la medicina. Por otra parte, muchas de las técnicas médicas actuales no han sido evaluadas hasta ahora. Una política de salud que otorgue el debido peso a amplias medidas sociales, es aplicable tanto a los países desarrollados como a los subdesarrollados. No obstante, esto puede involucrar cambios en las estructuras socioeconómicas subyacentes y, en concecuencia, encontrar obstáculos políticos. RESUMES Santé et société: réflections sur le système L'amélioration de la santé chez les populations des pays développés se doit, en grande partie, à un meilleur niveau de vie et aux mesures plus appropriées introduites par la santé publique, la médecine même n'y ayant joué qu'un rôle relativement minime. De plus, beaucoup de techniques médicales actuelles n'ont pas été adéquatement évaluées. Un programme de santé qui prend en juste considération l'ensemble des intérêts sociaux, serait applicable aussi bien pour les pays développés que sous?développés, mais ceci peut entraîner un changement fondamental des structures socio?économiques et rencontrer par conséquent des obstacles politiques

What is the 'problem' that outreach work seeks to address and how might it be tackled? Seeking theory in a primary health prevention programme

&lt;b&gt;Background&lt;/b&gt; Preventive approaches to health are disproportionately accessed by the more affluent and recent health improvement policy advocates the use of targeted preventive primary care to reduce risk factors in poorer individuals and communities. Outreach has become part of the health service response. Outreach has a long history of engaging those who do not otherwise access services. It has, however, been described as eclectic in its purpose, clientele and mode of practice; its effectiveness is unproven. Using a primary prevention programme in the UK as a case, this paper addresses two research questions: what are the perceived problems of non-engagement that outreach aims to address; and, what specific mechanisms of outreach are hypothesised to tackle these.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Methods&lt;/b&gt; Drawing on a wider programme evaluation, the study undertook qualitative interviews with strategically selected health-care professionals. The analysis was thematically guided by the concept of 'candidacy' which theorises the dynamic process through which services and individuals negotiate appropriate service use.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Results&lt;/b&gt; The study identified seven types of engagement 'problem' and corresponding solutions. These 'problems' lie on a continuum of complexity in terms of the challenges they present to primary care. Reasons for non-engagement are congruent with the concept of 'candidacy' but point to ways in which it can be expanded.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Conclusions&lt;/b&gt; The paper draws conclusions about the role of outreach in contributing to the implementation of inequalities focused primary prevention and identifies further research needed in the theoretical development of both outreach as an approach and candidacy as a conceptual framework

A review of clinical practice guidelines found that they were often based on evidence of uncertain relevance to primary care patients

Objectives: Primary care patients typically have less severe illness than those in hospital and may be overtreated if clinical guideline evidence is inappropriately generalized. We aimed to assess whether guideline recommendations for primary care were based on relevant research. Study Design and Setting: Literature review of all publications cited in support of National Institute for Health and Care Excellence (NICE) recommendations for primary care. The relevance to primary care of all 45 NICE clinical guidelines published in 2010 and 2011, and their recommendations, was assessed by an expert panel. Results: Twenty-two of 45 NICE clinical guidelines published in 2010 and 2011 were relevant to primary care. These 22 guidelines contained 1,185 recommendations, of which 495 were relevant to primary care, and cited evidence from 1,573 research publications. Of these cited publications, 590 (38%, range by guideline 6–74%) were based on patients typical of primary care. Conclusion: Nearly two-third (62%) of publications cited to support primary care recommendations were of uncertain relevance to patients in primary care. Guideline development groups should more clearly identify which recommendations are intended for primary care and uncertainties about the relevance of the supporting evidence to primary care patients, to avoid potential overtreatment