Tag Archives: Yonder

Yonder: Rosacea, youth mental health, diagnosing arthritis and telephone triage

F1.largeAhmed Rashid is an academic clinical fellow in general practice at the University of Cambridge. He writes the regular monthly column “Yonder” in the BJGP: a diverse selection of primary care relevant research stories from beyond the mainstream biomedical literature. Twitter: @Dr_A_Rashid

You can download the PDF here at BJGP.org.

Rosacea
Rosacea is a common, chronic skin condition in adults. As it predominantly affects the face, it has the potential to cause significant psychological and social distress. The internet has provided opportunities for patients to access information as well as interact with peers and experts. A US research team recently analysed posts on an online rosacea support forum to obtain insights into patients’ educational needs.1 They found that patients primarily sought advice about treatments, triggers, diet, and skin care. Perhaps unsurprisingly, there were also a large number of queries about the efficacy and adverse effects of therapies.

The authors suggest that doctors should make more attempts to include patients in their rosacea care and suggest that one way of doing this is to have them take pictures to track progress and keep a diary of potential triggers. They also suggest that proactively providing resources could help reduce confusion about the disease and treatments.

Youth mental health
Youth mental health is increasingly recognised as a priority area in health systems around the world. In particular, there has recently been an increased focus on early intervention and an Irish research team recently sought to examine the role of the GP in providing early treatment in this population.2

They combined a national survey of GPs with interviews of both health professionals and young people. They found that GPs were largely unsatisfied with their postgraduate training in child mental health and substance misuse. Access to services and youth workers were cited as key facilitators to improve care. Much like in the NHS, it seems an increase in funding for mental health services is also acutely needed in the Irish health system.

Diagnosing arthritis
Progress in rheumatoid arthritis management in recent years has meant that starting treatment early is more important than ever. However, this naturally relies on early identification and a Dutch rheumatology team recently examined the signs, symptoms, and investigations that GPs use in the diagnosis of inflammatory arthritis, analysing medical records.3 They used records from 16 practices and found 126 patients with new diagnoses of inflammatory arthritis. Information about classic inflammatory symptoms (pain, swelling, warmth, redness, reduced function) was frequently documented but items that they record as being routinely checked in secondary care (morning stiffness, family history and squeeze-test) were rarely used. In the UK, the increasing use of referral proformas with checklists may already have mostly ameliorated this issue.

Telephone triage
Practices are increasingly using telephone triage to manage patient flow but there are many unanswered questions about its effectiveness and safety. In the Netherlands, telephone triage in the daytime is done by practice assistants who generally have followed an intermediate vocational medical education of 3 years. A recent Dutch study sought to examine the adequacy of this triage, conducting a web-based survey asking practice assistants to assess the required type of care of written case scenarios with varying health problems and levels of urgency.4 They found that the required care was assessed adequately in 63.6% of cases, was over-estimated in 19.3%, and under-estimated in 17.1% and predictably, more experienced assistants and assistants with fixed daily work meetings with the GP performed better.

The authors conclude that telephone triage by general practice assistants is efficient, but potentially unsafe in highly urgent cases and suggest improved training is the key solution. As for NHS general practice, it seems increasingly likely that there will be more multidisciplinary working in years to come and this paper provides some insights into the kind of challenges (and opportunities) this may bring.

REFERENCES
1. Alinia  H, Moradi Tuchayi  S, Farhangian  ME, et al. (2016) Rosacea patients seeking advice: Qualitative analysis of patients’ posts on a rosacea support forum. J Dermatolog Treat 27(2):99–102.

2. Leahy  D, Schaffalitzky  E, Saunders  J, et al. (2015) Role of the general practitioner in providing early intervention for youth mental health: a mixed methods investigation. Early Interv Psychiatry doi:10.1111/eip.12303.

3. Newsum  EC, de Waal  MW, van Steenbergen  HW, et al. (2016) How do general practitioners identify inflammatory arthritis? A cohort analysis of Dutch general practitioner electronic medical records. Rheumatology (Oxford) pii:kev432.

4. Smits  M, Hanssen  S, Huibers  L, Giesen  P (2016) Telephone triage in general practices: A written case scenario study in the Netherlands. Scand J Prim Health Care 19:1–10.

Yonder: Health checks, insomnia, nursing homes and spirituality

F1.largeAhmed Rashid is an academic clinical fellow in general practice at the University of Cambridge. He writes the regular monthly column “Yonder” in the BJGP: a diverse selection of primary care relevant research stories from beyond the mainstream biomedical literature. Twitter: @Dr_A_Rashid

You can download the PDF here at BJGP.org.

Health checks
The NHS Health Check programme has divided opinion ever since it was first launched in 2008. The idea of proactively checking and managing an individual’s vascular risk may seem sensible but the evidence about the effectiveness of this approach has been lacking and has led to much debate in the medical community in recent years. As part of a contract with general practices to deliver this programme in the North West of England, a team of researchers recently surveyed GPs and practice managers across 55 practices.1

Time and software were key barriers to implementation, and payments were considered insufficient to cover the considerable increase in nursing workload that was required. With fewer than half of respondents deeming the programme beneficial to their practice, the paper concludes that practices will need much more support from commissioners if the programme continues to run.

Insomnia
Insomnia is extremely common and the cause of enormous frustration for patients, families, and GPs alike. A recent UK-based study sought to understand more about the causes of this frustration by interviewing both patients and health professionals in primary care settings in Nottinghamshire and Lincolnshire.2 Clinicians focused more on treatments rather than insomnia itself and felt advice about sleep hygiene was often disregarded. GPs often colluded with patients to prescribe hypnotics to avoid confrontation, and cognitive behavioural therapy (CBT) was rarely considered, despite being a recognised management option. Patients, meanwhile, often used hypnotics in ways that were not intended and felt GPs focused too much on the underlying causes of the insomnia rather than the impact of it.

Improving undergraduate and postgraduate medical training, establishing a recognised primary care pathway including pharmacists and local mental health services, and increasing public awareness of non-pharmaceutical treatment options were all suggested as possible strategies by the study authors.

Nursing homes
Nursing home residents are typically extremely frail and often have multimorbidity, polypharmacy, and multiple, complex medical and social needs requiring difficult medical decisions to be made. In Sweden, much like in the UK, GPs are usually responsible for the care of individuals in this setting and a recent study sought to understand what Swedish GPs thought about this aspect of their work.3 They described a discordance between the demands from staff and the actual need of care for the individual patients. However, despite the challenges, working in this setting was considered important and meaningful, with GPs feeling confident in their ability to provide a holistic and balanced approach. A positive and continuous relationship with nursing colleagues was considered one of the key aspects of the job and central to ensuring the wellbeing of residents.

Spirituality
In recent years, spirituality has become an increasingly well-recognised aspect of wellbeing that should be addressed as part of a holistic healthcare approach — particularly, for example, at the end of life. Traditionally, hospital chaplains have been recognised as spiritual carers, although religion is just one of many ways individuals can experience spirituality. In order to assimilate current thinking about the role of the doctor in the discussion of spirituality, an Australian research team conducted a systematic literature review identifying 54 studies comprising 12 327 individuals.4 In the majority of studies, over half of participants thought it was appropriate for the doctor to enquire about spiritual needs. However, preferences were not straightforward and there was a mismatch in perception between patients and doctors about what constitutes this discussion and therefore whether it has actually taken place.

Although patients do not expect their doctor to be a spiritual adviser, they do want holistic care and strong doctor–patient relationships, and the authors suggest therefore that efforts should be made to identify those patients who would welcome such discussions.

REFERENCES

1. Krska J, du Plessis R, Chellaswamy H (May, 2015) Views of practice managers and general practitioners on implementing NHS Health Checks. Prim Health Care Res Dev 20:1–8.
2. Davy Z, Middlemass J, Siriwardena AN (2015) Patients’ and clinicians’ experiences and perceptions of the primary care management of insomnia: qualitative study. Health Expect 18(5):1371–1383.
3. Bolmsjö BB, Strandberg EL, Midlöv P, Brorsson A (2015) ‘It is meaningful; I feel that I can make a difference’ — a qualitative study about GPs’ experiences of work at nursing homes in Sweden. BMC Fam Pract 16:111.
4. Best M, Butow P, Olver I (2015) Do patients want doctors to talk about spirituality? A systematic literature review. Patient Educ Couns 98(11):1320–1328.

Yonder: diabetes, orofacial pain, screening tests, and pharma

F1.largeAhmed Rashid is an academic clinical fellow in general practice at the University of Cambridge. He writes the regular monthly column “Yonder” in the BJGP: a diverse selection of primary care relevant research stories from beyond the mainstream biomedical literature. Twitter: @Dr_A_Rashid

You can download the PDF here at BJGP.org.

Diabetes
In recent years, improving care coordination and the interface between primary and secondary care have been particularly important targets for those designing diabetes services. A recent Australian study sought to investigate patients’ experiences of two GP-led integrated diabetes care services in Brisbane.1 They found that although patients listened to health professionals’ advice, the extent to which they were able to adopt it was determined unavoidably by their life circumstances. The various new relationships with different health professionals that resulted from the new service were another aspect that patients often found challenging to negotiate. The authors conclude that the flexible and personalised approach of a GP-led service can achieve good clinical outcomes and quality of life, although they emphasise the importance of preserving mutual trust between clinicians and patients in order to achieve this.

Orofacial pain
Pain in the face, mouth, and jaw is a common presentation to both medical and dental services and when it becomes persistent with no organic cause or trauma, it is labelled chronic orofacial pain (COFP). Although psychological treatments have been promising in clinical trials, they are not being widely used. In order to understand how a psychological approach may be better implemented in practice, a research team from Manchester interviewed patients with COFP as well as medical and dental practitioners.2 Although patients and clinicians recognised the importance of psychological factors as causes, they were largely focused on biomedical-management strategies. Dentists tended to view it as a non-dental problem, whereas GPs felt responsible to support patients using strategies adapted from other long-term conditions. The study suggests that improving the liaison between medical and dental services and increasing knowledge about the condition among GPs and dentists could help transform the care of this frustrating condition.

Screening tests
In recent years, there has been recognition from across the healthcare community that many clinical activities are ineffective and have the potential to cause physical and psychological harm. The Choosing Wisely campaign is an important part of the solution, highlighting ineffective tests and treatments that should be stopped or used less often. However, such strategies must include the views of patients and the public. A US team of researchers recently interviewed 50 individuals about what they thought of screening tests they’d been invited to take part in.3 Many participants could name no harms of screening and those that did, focused on harms of the screening test itself rather than those further along the management cascade. Benefits of screening, meanwhile, were easily identified and indeed, often overestimated. The study is a useful reminder that campaigns to save money or improve quality through disinvestment must focus on better communication with patients and the public.

Pharmaceutical industry interactions
The relationship between clinicians and the pharmaceutical industry has received considerable attention in the medical and lay press in recent years. Psychiatry has been a particularly high-profile discipline because of the nature of the drugs being prescribed. However, junior doctors in this specialty have yet to be investigated, prompting the European Federation of Psychiatric Trainees to survey trainee psychiatrists across 20 countries about their interactions with the pharmaceutical industry.4 The 62-item questionnaire was completed by over 1400 participants and demonstrated considerable variation across countries, with frequent interactions still taking place. The authors suggest creating alternative educational opportunities and specific training about the pharmaceutical industry to reduce the impact of industry marketing on psychiatric training. They also identify the importance of role models and encourage senior psychiatrists to reflect on the kind of examples they wish to set to their junior colleagues.

References
1. Burridge LH, Foster MM, Donald M, et al. (2015) Making sense of change: patients’ views of diabetes and GP-led integrated diabetes care. Health Expect doi:10.1111/hex.12331, [Epub ahead of print].
2. Peters S, Goldthorpe J, McElroy C, et al. (2015) Managing chronic orofacial pain: a qualitative study of patients’, doctors’, and dentists’ experiences. Br J Health Psychol doi:10.1111/bjhp.12141, [Epub ahead of print].
3. Sutkowi-Hemstreet A, Vu M, Harris R, et al. (Apr 14, 2015) Adult patients’ perspectives on the benefits and harms of overused screening tests: a qualitative study. J Gen Intern Med, [Epub ahead of print].
4. Riese F, Guloksuz S, Roventa C, et al. (2015) Pharmaceutical industry interactions of psychiatric trainees from 20 European countries. Eur Psychiatry 30(2):284–290.

Yonder: Practice nurses, Ehlers-Danlos syndrome, fitness to drive, and Balint groups

F1.largeAhmed Rashid is an academic clinical fellow in general practice at the University of Cambridge. He writes the regular monthly column “Yonder” in the BJGP: a diverse selection of primary care relevant research stories from beyond the mainstream biomedical literature. Twitter: @Dr_A_Rashid

You can download the PDF here at BJGP.org.

Practice nurses
In the UK, much like the rest of the world, a huge proportion of patients with mental health conditions are managed exclusively in primary care, with no specialist psychiatric input. Practice nurses make up a substantial part of the primary care workforce and are increasingly involved in managing long-term conditions. Traditionally, however, mental health has not often been part of their remit and training opportunities have been rare. In a recent study, a primary care mental health expert developed a programme of education designed specifically for practice nurses.1 The ‘train the trainer’ model was used to prepare 24 mental health nurses in North London to deliver the teaching. Both the practice nurses and mental health nurses felt their clinical practice would improve as a result of taking part. As we move to more integrated models of mental healthcare delivery, these collaborations could prove invaluable.

Ehler-Danlos syndrome
An inherited, lifelong connective tissue disorder characterised by joint hypermobility and a number of possible systemic features, Ehlers-Danlos syndrome (EDS) can have a significant impact on many aspects of patients’ lives. Given the complexity of the condition, frequency of chronic pain, and absence of objective physical signs, individuals with EDS are often referred for psychiatric assessment. Researchers from Sweden recently sought to identify levels of anxiety in EDS patients using postal questionnaires.2 The 250 individuals that responded had considerably higher levels of anxiety and depression than a Swedish general population group. They also had significantly lower health-related quality of life. The authors highlight that, although EDS is a lifelong condition with limited treatment options, offering more personalised interventions and acknowledging the psychosocial burden of the condition may help individuals manage their daily lives.

Fitness to drive
Driving allows people to work, socialise, and maintain self-confidence and independence. Stopping driving can have negative health and social effects, although clearly can be essential in certain circumstances such as unstable epilepsy and significant visual impairment. GPs in Ireland, like those in the UK, are expected to assess medical fitness to drive despite receiving little or no training to prepare them to do so.

A group of Irish researchers recently used postal questionnaires to survey 527 GPs about this.Although many of them felt confident in their ability to make these assessments, there was ambivalence about who should be primarily responsible to complete them. Some GP responders would consider referring for more specialist opinion if the option were to become available. Many GPs felt their skills in this area were limited and dealing with patient and family pressure and requests for legal clarifications were particularly problematic areas.
Balint Groups

Balint groups
Michael Balint, a London-based psychoanalyst, introduced seminars for GPs in the 1950s that would go on to spread across the world, helping clinicians broaden their perspectives on challenging clinical interactions through case-based presentations and discussions. In a recent review published in Patient Education and Counselling,4 Belgian researchers found that the peer-reviewed literature on Balint groups remains scarce. The research that exists, meanwhile, tends to be diversely reported and methodologically weak, although they found many rich reflective accounts and reports about the benefits they have had for individual clinicians. As studies reported effects (for example, psychosocial self-efficacy, and reduced burnout) only after long-term participation, the authors highlight the importance of organising groups for a sufficient length of time (they suggest 1–1.5 years) to allow for change. As a Balint group enthusiast, I hope this review will prompt further interest and research funding to help convince policymakers of the enormous value of these groups to healthcare professionals, and in particular, GPs.

References

1. Hardy SA, Kingsnorth R (2015) Mental health nurses can increase capability and capacity in primary care by educating practice nurses: an evaluation of an education programme in England. J Psychiatr Ment Health Nurs 22(4):270–277.
2. Berglund B, Pettersson C, Pigg M, Kristiansson P (2015) Self-reported quality of life, anxiety and depression in individuals with Ehlers-Danlos syndrome (EDS): a questionnaire study. BMC Musculoskelet Disord 16(1):89.
3. Kahvedžic A, Mcfadden R, Cummins G, et al. (2015) General practitioner attitudes and practices in medical fitness to drive in Ireland. J Transp Health 2(2):284–288.
4. Van Roy K, Vanheule S, Inslegers R (2015) Research on Balint groups: a literature review. Patient Educ Couns 98(6):685–694.

Yonder: prostate biopsy, childhood vaccination, oral health and medical tourism

F1.largeAhmed Rashid is an academic clinical fellow in general practice at the University of Cambridge. He writes the regular monthly column “Yonder” in the BJGP: a diverse selection of primary care relevant research stories from beyond the mainstream biomedical literature. Twitter: @Dr_A_Rashid

You can download the PDF here at BJGP.org.

Prostate biopsy
Prostate cancer remains one of the commonest causes of cancer death in the world and as active surveillance becomes an increasingly accepted alternative to radical treatment, the use of biopsies has extended to include monitoring as well as diagnosis. Transrectal ultrasound guided biopsy (TRUS-Bx) is therefore one of the most commonly performed urological procedures in the world. In a recent qualitative study embedded in a large randomised controlled trial, researchers from Bristol sought to compare men’s experiences of these biopsies compared to the expectations they had before it.1 Although TRUS-Bx was generally well tolerated, around one-quarter of men experienced problematic side effects and anxiety. In these cases, experiences tended to deviate from the information that they had received and they, therefore, felt unprepared for elements of the procedure or its sequelae. The study findings have been used to design an updated, comprehensive, evidence-based patient information leaflet and the authors reiterate the need for detailed discussions when counselling men about this procedure.

Childhood vaccination
Childhood vaccinations are such a routine part of modern health care that it can be easy to underestimate the huge reductions in global mortality that they have led to. However, despite increases in uptake, rates remain suboptimal with vaccine-preventable diseases still a public health risk in most parts of the world. A recent systematic review identified 28 studies evaluating parental interventions developed to improve early childhood (0–5 years) vaccine uptake.2 Receiving both postal and telephone reminders was the most successful reminder-based intervention. Educational interventions, meanwhile, were most successful in lower-income countries and when conducted through discussion. As you might imagine, the precise effectiveness of interventions depended on a number of factors, including the country and levels of parental vaccine hesitancy in the target population.

Oral health
Although health-related quality of life is a well-established outcome metric in medical research, the field of oral health has lagged behind. Several measures have attempted to capture how oral health impacts on quality of life but have all been directed to older adult populations. A team of public health researchers from Yale University recently sought to develop a questionnaire addressing issues that were more relevant to young adults.3 An initial item tool that included physical, psychological, and social constructs (developed by oral health experts) was sent to 553 adult participants via an online questionnaire. Scores on the self-perception and anxiety subscale were highest in this cohort (average age of 28 years) and tooth colour appeared to be the biggest concern. The initial psychometric properties of the survey were promising, and given that 80% of questions on previous instruments related to dentures, future studies should now be better placed to measure the impact of oral conditions on all age groups.

Medical tourism
The surge of UKIP in the recent general election has brought the term medical tourism into the public vocabulary. Although the political focus has been on the use of the NHS by visitors from abroad, many patients choose to leave the UK to pursue treatments from other parts of the world. The literature in this area is growing, although studies to date have focused mainly on specific types of procedures for which patients travel, including cosmetic, dental, and fertility treatments.

In a Social Science & Medicine article, a team of researchers sought to explore why and where patients from the UK choose to travel for health care.4 They found that while distance, costs, expertise, and availability of treatment were all factors influencing the decision to travel, choice of individual provider was based on informal networks including web for a, support groups, and personal recommendations. The authors suggest that given the importance of these networks, they may be an important target for efforts aimed at regulating medical tourism. Exactly how much regulation is needed is probably the more fundamental issue politically.

References

1. Wade J, Rosario DJ, Howson J, et al. (2015) Role of information in preparing men for transrectal ultrasound guided prostate biopsy: a qualitative study embedded in the ProtecT trial. BMC Health Serv Res 28(15):80.
2. Harvey H, Reissland N, Mason J (2015) Parental reminder, recall and educational interventions to improve early childhood immunisation uptake: a systematic review and meta-analysis. Vaccine 33(25):2862–2880, doi:10.1016/j.vaccine.2015.04.085.
3. Daneshvar M, Devji TF, Davis AB, White MA (Apr 17, 2015) Oral health related quality of life: a novel metric targeted to young adults. J Public Health Dent doi:10.1111/jphd.12099, [Epub ahead of print].
4. Hanefeld J, Lunt N, Smith R, Horsfall D (2015) Why do medical tourists travel to where they do? The role of networks in determining medical travel. Soc Sci Med 124:356–363.

Yonder: Choosing a GP, breast cancer, patient safety, and online dating

F1.largeAhmed Rashid is an academic clinical fellow in general practice at the University of Cambridge. He writes the regular monthly column “Yonder” in the BJGP: a diverse selection of primary care relevant research stories from beyond the mainstream biomedical literature. Twitter: @Dr_A_Rashid

You can download the PDF here at BJGP.org.

Choosing a GP.
The NHS constitution gives patients the right to choose the GP surgery they want to register at and to express a preference to see a particular doctor within that surgery. In a recent Australian study, researchers studied the factors that are taken into consideration when choosing a GP.1 Their online survey was filled in by 2481 adults. The most important factor was care quality, which included technical and interpersonal care as well as continuity, and the authors felt the emphasis when publicising practices should be on the manner in which care is delivered, rather than the types of care that are available. Despite the important difference that cost is not a factor in the NHS (and is in the Australian health system), the study is a useful reminder that patient priorities must be central to the way practices are designed and promoted

Breast cancer.
Advances in breast cancer treatment mean even for those with metastatic disease, there is an increasingly long period of time between diagnosis and end of life. The uncertainty of living with metastatic breast cancer and the vulnerability to physical and psychological issues while living with this diagnosis prompted a group of researchers to investigate the information and support needs of this population, interviewing 18 women in total.2 The results show that these patients deeply value relationships with health professionals, and in particular for this group, their oncologists. However, many women felt their clinicians did not appreciate the extent to which treatment side effects impact on quality of life. In addition, participants felt better supported when they had early breast cancer than following the diagnosis of metastatic disease. The authors suggest improving information provision specifically about advanced disease should therefore be a priority.

Patient safety. Vast numbers of patients are treated effectively and safely in general practice every day. However, among the complexity of consultations, prescriptions, visits, letters, and computer systems, the potential for patient safety issues is high. In recent years, there has been much focus on developing the right culture and systems to minimise the potential for harm. In a recent Globalization & Health study, a Leicester research team explored the views of health workers in low-income settings about the obstacles to ensuring patient safety.3 A total of 57 doctors, nurses, administrators, and managers from East Africa were interviewed. As is the case in high-income countries, front-line staff were able to provide valuable insights into patient safety challenges. It was particularly interesting to note that, despite the difference in material resources, key themes were remarkably similar to those in the NHS and included teamwork, professional hierarchies, and governance. This reaffirms that human factors, leadership, and culture really are central to embedding patient safety into any organisation.

Online dating. Evidence-based medicine approaches have helped to answer countless clinical questions and clarify some great mysteries of the medical world. Two clinical researchers from either side of the Atlantic Ocean recently decided to use a systematic review to find out whether there was an optimal, evidence-based approach to online dating.4 In order to do this, they searched the literature in a number of disciplines including psychology, sociology, and computer and behavioural sciences, finding 86 studies for inclusion. A desirable screen name (starting with a letter in the first half of the alphabet), an attractive still picture, and a fluent headline message are important to capture initial interest. Meanwhile, invitations to potential dates are most likely to be accepted if they contained short personalised messages addressing a trait mentioned in their profile, or extended genuine compliments. In the acknowledgements, the authors thank the potential dates who turned one of them down repeatedly and encouraged them to take this evidence-based approach!

References

1. Kenny P, De Abreu Lourenco R, Wong CY, et al. (Jan 7, 2015) Community preferences in general practice: important factors for choosing a general practitioner. Health Expect doi:10.1111/hex.12326, [Epub ahead of print].
2. Lewis S, Yee J, Kilbreath S, Willis K (2015) A qualitative study of women’s experiences of healthcare, treatment and support for metastatic breast cancer. Breast doi:10.1016/j.breast.2015.02.025, pii: S0960-9776(15)00040-5, [Epub ahead of print].
3. Aveling EL, Kayonga Y, Nega A, Dixon-Woods M (2015) Why is patient safety so hard in low-income countries? A qualitative study of healthcare workers’ views in two African hospitals. Globalization and Health 11:6.
4. Khan KS, Chaudhry S (2015) An evidence-based approach to an ancient pursuit: systematic review on converting online contact into a first date. Evid Based Med 20(2):48–56.

Paracetamol, ethnic health inequalities, cerebral palsy, and pornography

F1.largeAhmed Rashid is an academic clinical fellow in general practice at the University of Cambridge. He writes the regular monthly column “Yonder” in the BJGP: a diverse selection of primary care relevant research stories from beyond the mainstream biomedical literature. Twitter: @Dr_A_Rashid

You can download the PDF here at BJGP.org.

Paracetamol
A recent study from South Africa, published in Patient Education & Counselling, is titled ‘But it’s just paracetamol’ — a phrase and sentiment that most GPs will be more than familiar with. The study sought to determine whether caregivers could make informed decisions about administering over-the-counter analgesia to children.1 In particular, they sought to explore whether the information provided by paracetamol labels, inserts, and patient information leaflets was adequate. The researchers spoke to caregivers from a church mothers’ group and a sample of local pharmacists in Cape Town. Their results indicate that most caregivers found it difficult to understand the scientific information in all three mechanisms of information provision. Although patient information leaflets were deemed easiest to understand, few caregivers received these with their purchase. The authors suggest that using simpler language in text and more verbal counselling could help improve safety and literacy.

Ethnic health inequalities
Ethnic minority populations living in economically developed countries are at particularly high risk of developing obesity, diabetes, and cardiovascular disease. Improving access to health promotion interventions therefore has the potential to reduce the burden of long-term conditions and reduce ethnic health inequalities. A team of researchers from Edinburgh recently sought to explore the perspectives of health researchers and promoters working with ethnic minority populations in the areas of smoking cessation, increased physical activity, and healthy eating, to better understand the process of adapting interventions. Their interview study was published in Health Promotion International.2 Among a number of thought-provoking findings, the study highlights the important context of demographic variables such as age and sex, and how these can significantly alter the way people interpret and participate in health promotion interventions. The authors suggest that the contextual experiences surrounding ethnicity considerations shape the receptivity, durability, and continuity of these adapted interventions.

Cerebral palsy
Infantile cerebral palsy (ICP) is the commonest cause of physical disability in childhood. The birth of a child with this condition can have huge implications for a family and cause complex and changing emotions in the parents. In a recent Spanish study published in Disability & Health Journal, researchers sought to understand the experience of adjustment to a child with disability.3 A total of 24 parents of 18 children with ICP were interviewed. The most traumatic experience for these parents was the loss of the ideal child they had expected. Many spoke about how they constantly compare how life would have been if their child had not been born with ICP. The authors suggest that, whenever possible, individual sessions that encourage emotional support and normalise all loss-related feelings should be provided to parents.

Pornography
The internet has transformed pornography use and has facilitated a dramatic increase in its popularity, such that it is now a multi-billion-pound global industry. Although a vast body of evidence has established the negative effect that viewing pornography can have on beliefs and attitudes, there has been comparatively less research about whether it also influences behaviours. A US-based team of psychology researchers recently sought to explore the association between viewing pornography and engaging in potentially risky sexual behaviours (or, as they call it in the article, ‘hooking up’).4 They recruited nearly 1000 college students and used online surveys to gather data. Their results indicate that more frequent viewing of pornography is associated with a higher incidence of hooking up and a higher number of unique hook-up partners. They discuss their findings in the context of the associated literature that connects hook-ups with alcohol consumption and lack of condom use. The paper concludes that it may be worthwhile to seek out pornography consumers in order to educate them. That should be easy enough!

References

1. Bennin F, Rother A (2015) ‘But it’s just paracetamol’: caregivers’ ability to administer over-the-counter painkillers to children with the information provided. Patient Educ Couns 98(3):331–337.
2. Liu J, Davidson E, Bhopal R, et al. (2015) Adapting health promotion interventions for ethnic minority groups: a qualitative study. Health Promot Int pii:dau105, [Epub ahead of print].
3. Fernandez-Alcantra, García-Caro MP, Laynez-Rubio C, et al. (2015) Feelings of loss in parents of children with infantile cerebral palsy. Disabil Health J 8(1):93–101.
4. Braithwaite SR, Coulson G, Keddington K, Fincham FD (2015) The influence of pornography on sexual scripts and hooking up among emerging adults in college. Arch Sex Behav 44(1):111–123.

URTI, menopause, universal health coverage, and chocolate cravings

F1.largeAhmed Rashid is an academic clinical fellow in general practice at the University of Cambridge. He writes the regular monthly column “Yonder” in the BJGP: a diverse selection of primary care relevant research stories from beyond the mainstream biomedical literature. Twitter: @Dr_A_Rashid

You can download the PDF here at BJGP.org.

Childhood upper respiratory tract infection (URTI). Childhood URTI is one of the commonest reasons for parents to consult in primary care. One would think that this makes it an easy type of consultation for doctors to tackle. However, the age-old antibiotic debate still rears its ugly head and has the potential to lead to much miscommunication and misunderstanding. With antimicrobial resistance high on the public health agenda, these interactions have received particular attention recently. In a study published in Patient Education and Counselling, researchers in Bristol interviewed 30 such parents from a variety of socioeconomic areas.1 They found that parents’ perceptions about the credibility of diagnosis and treatment recommendations were highly influenced by clinician communication. They suggest clinicians should focus on symptoms of particular concern to parents and give more precise safety net advice. Interestingly, they found the term ‘viral’ often trivialised the condition and contradicted the parents’ perception of severity. Although an important part of the antibiotic discussion, this explanation needs to be used sensitively with parents.

[bctt tweet=”BJGP Blog – parents found the term ‘viral’ often trivialised URTIs and needs to be used sensitively.”]

Menopause. Throughout the world, experiences of menopause vary enormously and these are greatly shaped by socioeconomic and cultural influences. Although women’s perspectives about menopause have been investigated extensively, men’s views on the subject have received much less attention. Menopause can cause an array of physical and psychological symptoms that have the potential to dramatically affect quality of life and relationships. In order to understand men’s views about menopause, a group of Turkish researchers interviewed 33 married men from Istanbul who were aged 40–77 years. The study, published in the Journal of Pakistan Medical Association, highlighted a clear lack of basic knowledge and a lack of understanding about the treatment options available.2 Participants varied in their willingness to discuss intimate issues but there were clear concerns about their own sex lives. The authors state that clinicians should remember to involve men when delivering health information to women at this crucial time.

Universal health coverage. The NHS is fantastic and we should be proud of it and celebrate it every day. Despite all the problems and challenges, we must not take for granted the fact that health care in this country is free at the point of use. Across the developing world, the drive to reach universal health coverage relies enormously on primary care infrastructure and many countries look towards the British model as a gold standard. In Sub-Saharan Africa, health reforms have tended to be top-down ignoring the perspective of rural communities. Malawi has adopted an ‘essential health package’ to support universal free health coverage and in a recent BMC Health Services Research article,3 rural community residents highlighted various shortcomings of the system, including geographical inequities, affordability and transport problems, healthcare worker shortages, and poor quality of services. It provides a good example of how rural communities are often overlooked in health reforms and should provide local evidence reflecting context-specific needs.

Chocolate cravings. Chocolate has been around for centuries and remains a popular food type and flavour throughout the world. As well as being incredibly popular, it also elicits strong cravings. It was therefore a good choice for a group of health psychologists wanting to examine two mindfulness techniques. The study published in the British Journal of Health Psychology involved a group of 137 university students wishing to reduce their chocolate consumption.4 Participants were allocated to either a ‘defusion’ or ‘acceptance’ mindfulness strategy, or to a conventional relaxation strategy as a control intervention.

The results indicate that individuals in the ‘defusion’ group successfully resisted chocolate over 5 days, although this was not the case for the ‘acceptance’ group. The study demonstrates that although mindfulness can be useful, determining which strategies are helpful for different situations should help enhance the efficacy and cost-effectiveness of interventions.

[bctt tweet=”BJGP Blog: A ‘defusion’ mindfulness strategy could help you resist chocolate…”]

References

1. Cabral  CIngram  JHay  ADHorwood  J, TARGET team. {2014‘They just say everything’s a virus’ — parent’s judgment of the credibility of clinician communication in primary care consultations for respiratory tract infections in children: a qualitative studyPatient Educ Couns 95(2):248253

2. Hidiroglu  STanriover  OAy  PKaravus  M. (2014A qualitative study on menopause described from the man’s perspectiveJ Pak Med Assoc 64(9):10311036

3. Abiiro  GMbera  GBDe Allegri  (2014Gaps in universal health coverage in Malawi: a qualitative study in rural communitiesBMC Health Serv Res 22(14):234.

4. Jenkins  KTTapper  (2014Resisting chocolate temptation using a brief mindfulness strategyBr J Health Psychol 19(3):509522.