http://www.biomedcentral.com/bmcfampract/ The latest research articles published by BMC Family Practice 2012-05-30T00:00:00Z Background: Obesity is a significant public health concern. General practitioners (GPs) see a large percentage of the population and are well placed to provide weight management advice. There has been little examination of the types of weight loss strategies used in Australian general practice patients. This cross-sectional study aimed to describe the proportion of normal weight, overweight and obese general practice patients who report trying to lose weight in the past 12 months, the types of weight loss strategies and diets used as well as the proportion consulting their GP prior to trying to lose weight. Methods: Adult patients completed a touchscreen computer survey while waiting for their appointment. Responses from 1335 patients in twelve Australian practices are reported. Results: A larger proportion of obese patients had tried to lose weight in the past 12 months (73%) compared to those who were overweight (55%) and normal weight (33%). The most commonly used strategy used was changing diet and increasing exercise in all BMI categories. Less than 10% used strategies such as prescription medication, over the counter supplements and consulted a weight loss specialist. Low calorie and low fat diets were the most frequently reported diets used to lose weight in those who were normal weight, overweight and obese. Overall, the proportion seeking GP advice was low, with 12% of normal weight, 15% of overweight and 43% of obese patients consulting their GP prior to trying to lose weight. Conclusions: A large proportion of overweight or obese patients have tried to lose weight and utilized strategies such as changing diet and increasing exercise. Most attempts however were unassisted, with low rates of consultation with GPs and weight loss specialists. Ways to assist overweight and obese general practice patients with their weight loss attempts need to be identified. http://www.biomedcentral.com/1471-2296/13/48 Sze Lin Yoong Carey Mariko Robert Sanson-Fisher Catherine D'Este BMC Family Practice 2012, null:48 2012-05-30T00:00:00Z doi:10.1186/1471-2296-13-48 /content/figures/1471-2296-13-48-toc.gif BMC Family Practice 1471-2296 ${item.volume} 48 2012-05-30T00:00:00Z PDF Background: Family and community medicine (FM) became a recognized specialty in Spain in 1978; however, most medical schools in Spain still lack mandatory core courses in FM. As part of a larger study that evaluates medical student attitudes and perceptions about primary care (PC) in university education and in the National Health System, we present the first cross-sectional results. Methods: The study population was all first-, third-, and fifth-year students (2009-2010) in 22 participating medical schools in Spain (of 27 total). The 83-item survey had three sections: personal data, FM training, and professional practice expectations/preferences). Chi-squared test or analysis of variance were used, as appropriate. Results: We had a 41.8% response rate (n=5299/12667); 89.8% considered the social role of FM to be essential, while 20% believed the specialty was well respected within the medical profession. The appeal of FM increased with years of study, independent of student characteristics or medical school attended. Among third and fifth-year students, 54.6% said their specialty preferences had changed during medical school; 73.6% felt that FM specialists should teach FM courses, and 83.3% thought that FM rotations in primary care centers were useful. Conclusions: Students valued the social role of FM more highly than its scientific standing. The vast majority believe that FM training should be mandatory. Only 25% of first-year students have clear preferences for a specialization. Interest in FM increases moderately over their years of study. Working conditions in FM have decisive influence in choosing a specialty. http://www.biomedcentral.com/1471-2296/13/47 Amando Martín Zurro Josep Jiménez Villa Antonio Monreal Hijar Xavier Mundet Tuduri Ángel Otero Puime Pablo Alonso-Coello BMC Family Practice 2012, null:47 2012-05-29T00:00:00Z doi:10.1186/1471-2296-13-47 /content/figures/1471-2296-13-47-toc.gif BMC Family Practice 1471-2296 ${item.volume} 47 2012-05-29T00:00:00Z PDF Background: The prevention of type 2 diabetes is a recognised health care priority globally. Within the United Kingdom, there is a lack of research investigating optimal methods of translating diabetes prevention programmes, based on the promotion of a healthy lifestyle, into routine primary care. This study aims to establish the behavioural and clinical effectiveness of a structured educational programme designed to target perceptions and knowledge of diabetes risk and promote a healthily lifestyle, particularly increased walking activity, in a multiethnic population at a high risk of developing type 2 diabetes.DesignCluster randomised controlled trial undertaken at the level of primary care practices. Followup will be conducted at 12, 24 and 36 months. The primary outcome is change in objectively measured ambulatory activity. Secondary outcomes include progression to type 2 diabetes, biochemical variables (including fasting glucose, 2-h glucose, HbA1c and lipids), anthropometric variables, quality of life and depression. Methods: 10 primary care practices will be recruited to the study (5 intervention, 5 control). Within each practice, individuals at high risk of impaired glucose regulation will be identified using an automated version of the Leicester Risk assessment tool. Individuals scoring within the 90th percentile in each practice will be invited to take part in the study. Practices will be assigned to either the control group (advice leaflet) or the intervention group, in whichparticipants will be invited to attend a 3 hour structured educational programme designed to promote physical activity and a healthy lifestyle. Participants in the intervention practices will also be invited to attend annual group-based maintenance workshops and will receive telephone contact halfway between annual sessions. The study will run from 2010-2014.DiscussionThis study will provide new evidence surrounding the long-term effectiveness of a diabetes prevention programme run within routine primary care in the United Kingdom.Trial RegistrationClinicalTrials.Gov identifier: NCT00941954 http://www.biomedcentral.com/1471-2296/13/46 Thomas Yates Melanie Davies Joe Henson Jacqui Troughton Charlotte Edwardson Laura Gray Kamlesh Khunti BMC Family Practice 2012, null:46 2012-05-29T00:00:00Z doi:10.1186/1471-2296-13-46 /content/figures/1471-2296-13-46-toc.gif BMC Family Practice 1471-2296 ${item.volume} 46 2012-05-29T00:00:00Z PDF Background: Comparatively few studies address the problems related to multimorbidity. This is surprising, since multimorbidity is a particular challenge for both general practitioners and patients. This study focuses on the latter, analyzing the way patients aged 65-85 cope with multimorbidity. Methods: 19 narrative in-depth interviews with multimorbid patients were conducted. The data was analysed using grounded theory. Of the 19 interviewed patients 13 were female and 6 male. Mean age was 75 years. Participating patients showed a relatively homogeneous socio-economic status. Patients were recruited from the German city of Hamburg and the state of North Rhine-Westphalia. Results: Despite suffering from multimorbidity, interviewees held positive attitudes towards life: At the social level, patients tried to preserve their autonomy to the most possible extent. At the emotional level, interviewees oscillated between anxiety and strength - having, however, a positive approach to life. At the practical level, patients aimed at keeping their diseases under control. The patients tended to be critical in regards to medication. Conclusions: These findings might have implications for the treatment of multimorbid patients in primary care and further research: The generally presumed passivity of older individuals towards medical treatment, which can be found in literature, is not evident among our sample of older patients. In future, treatment of these patients might take their potential for pro-active cooperation more strongly into account than it is currently the case. http://www.biomedcentral.com/1471-2296/13/45 Christin Loeffler Hanna Kaduszkiewicz Carl-Otto Stolzenbach Waldemar Streich Angela Fuchs Hendrick van den Bussche Friederike Stolper Attila Altiner BMC Family Practice 2012, null:45 2012-05-29T00:00:00Z doi:10.1186/1471-2296-13-45 /content/figures/1471-2296-13-45-toc.gif BMC Family Practice 1471-2296 ${item.volume} 45 2012-05-29T00:00:00Z PDF Background: People with low health literacy may not have the capacity to self-manage their health and prevent the development of chronic disease through lifestyle risk factor modification. The aim of this narrative synthesis is to determine the effectiveness of primary healthcare providers in developing health literacy of patients to make SNAPW (smoking, nutrition, alcohol, physical activity and weight) lifestyle changes. Methods: Studies were identified by searching Medline, Embase, Cochrane Library, CINAHL, Joanna Briggs Institute, Psychinfo, Web of Science, Scopus, APAIS, Australian Medical Index, Community of Science and Google Scholar from 1 January 1985 to 30 April 2009. Health literacy and related concepts are poorly indexed in the databases so a list of text words were developed and tested for use. Hand searches were also conducted of four key journals. Studies published in English and included males and females aged 18 years and over with at least one SNAPW risk factor for the development of a chronic disease. The interventions had to be implemented within primary health care, with an aim to influence the health literacy of patients to make SNAPW lifestyle changes. The studies had to report an outcome measure associated with health literacy (knowledge, skills, attitudes, self efficacy, stages of change, motivation and patient activation) and SNAPW risk factor. The definition of health literacy in terms of functional, communicative and critical health literacy provided the guiding framework for the review. Results: 52 papers were included that described interventions to address health literacy and lifestyle risk factor modification provided by different health professionals. Most of the studies (71 %, 37/52) demonstrated an improvement in health literacy, in particular interventions of a moderate to high intensity. Non medical health care providers were effective in improving health literacy. However this was confounded by intensity of intervention. Provider barriers impacted on their relationship with patients. Conclusion: Capacity to provide interventions of sufficient intensity is an important condition for effective health literacy support for lifestyle change.This has implications for workforce development and the organisation of primary health care. http://www.biomedcentral.com/1471-2296/13/44 Sarah Dennis Anna Williams Jane Taggart Anthony Newall Elizabeth Denney Wilson Nicholas Zwar Timothy Shortus Mark Harris BMC Family Practice 2012, null:44 2012-05-28T00:00:00Z doi:10.1186/1471-2296-13-44 /content/figures/1471-2296-13-44-toc.gif BMC Family Practice 1471-2296 ${item.volume} 44 2012-05-28T00:00:00Z PDF Background: Information about antibiotic prescribing practice in primary care is not available for Ireland, unlike other European countries. The study aimed to ascertain the types of antibiotics and the corresponding conditions seen in primary care and whether general practitioners (GPs) felt that an antibiotic was necessary at the time of consultation. This information will be vital to inform future initiatives in prudent antibiotic prescribing in primary care. Methods: Participating GPs gathered data on all antibiotics prescribed by them in 100 consecutive patients' consultations as well as data on the conditions being treated and whether they felt the antibiotic was necessary. Results: 171 GPs collected data on 16,899 consultations. An antibiotic was prescribed at 20.18% of these consultations. The majority were prescribed for symptoms or diagnoses associated with the respiratory system; the highest rate of prescribing in these consultations were for patients aged 15-64 years (62.23%). There is a high rate of 2nd and 3rd line agents being used for common ailments such as otitis media and tonsillitis. Amoxicillin, which is recommended as 1st line in most common infections, was twice as likely to be prescribed if the prescription was for deferred used or deemed unnecessary by the GP. Conclusion: The study demonstrates that potentially inappropriate prescribing is occurring in the adult population and the high rate of broad spectrum antimicrobial agents is a major concern. This study also indicates that amoxicillin may be being used for its placebo effect rather than specifically for treatment of a definite bacterial infection. http://www.biomedcentral.com/1471-2296/13/43 Marion Murphy Colin Bradley Stephen Byrne BMC Family Practice 2012, null:43 2012-05-28T00:00:00Z doi:10.1186/1471-2296-13-43 /content/figures/1471-2296-13-43-toc.gif BMC Family Practice 1471-2296 ${item.volume} 43 2012-05-28T00:00:00Z PDF Background: To our knowledge, no study has examined quality of life (QoL) among caregivers of individuals with schizophrenia between a developing and a developed country. The aim of this study was to assess QoL of the caregivers of individuals with schizophrenia in two countries characterized by different social, economic and cultural conditions, namely Chile and France. Methods: Data were collected from public mental health outpatient services in Arica (Chile), and in Marseille (France). QoL was measured with the short-form health survey scale - 36 items (SF36). QoL of 41 Chilean caregivers was firstly compared with 245 French caregivers. Univariate and multivariate analyses using linear regression were then performed to determine variables potentially related to QoL scores. Results: The caregivers were primarily mothers in the two groups, but Chilean caregivers were younger, and lived more frequently with the individual with schizophrenia than French caregivers. The SF36 scores were globally low in the two groups, especially on the mental QoL scores. Chilean caregivers reported lower physical SF36 scores than French caregivers. In the multivariate analysis, being mother and Chilean caregivers were the most regular features associating to a lower QoL. Conclusion: Despite differences between Chile and France, especially in terms of quality and quantity of mental health services and economic supports, caregivers' QoL levels remain particularly low for both countries. Future support programmes should address the specific needs of caregivers http://www.biomedcentral.com/1471-2296/13/42 Laurent Boyer Alejandra Caqueo-Urízar Raphaelle Richieri Christophe Lancon José Gutiérrez-Maldonado Pascal Auquier BMC Family Practice 2012, null:42 2012-05-28T00:00:00Z doi:10.1186/1471-2296-13-42 /content/figures/1471-2296-13-42-toc.gif BMC Family Practice 1471-2296 ${item.volume} 42 2012-05-28T00:00:00Z PDF Background: Clinicians are encouraged to screen people with chronic physical illness for depression. Screening alone may not improve outcomes, especially if the process is incompatible with patient beliefs. The aim of this research is to understand people's beliefs about depression, particularly in the presence of chronic physical disease. Methods: A mixed method systematic review involving a thematic analysis of qualitative studies and quantitative studies of beliefs held by people with current depressive symptoms. MEDLINE, EMBASE, PSYCHINFO, CINAHL, BIOSIS, Web of Science, The Cochrane Library, UKCRN portfolio, National Research Register Archive, Clinicaltrials.gov and OpenSIGLE were searched from database inception to 31st December 2010. A narrative synthesis of qualitative and quantitative data, based initially upon illness representations and extended to include other themes not compatible with that framework. Results: A range of clinically relevant beliefs was identified from 65 studies including the difficulty in labeling depression, complex causal factors instead of the biological model, the roles of different treatments and negative views about the consequences of depression. We found other important themes less related to ideas about illness: the existence of a self-sustaining 'depression spiral'; depression as an existential state; the ambiguous status of suicidal thinking; and the role of stigma and blame in depression. Conclusions: Approaches to detection of depression in physical illness need to be receptive to the range of beliefs held by patients. Patient beliefs have implications for engagement with depression screening. http://www.biomedcentral.com/1471-2296/13/41 Sarah Alderson Robbie Foy Liz Glidewell Kate McLintock Allan House BMC Family Practice 2012, null:41 2012-05-28T00:00:00Z doi:10.1186/1471-2296-13-41 /content/figures/1471-2296-13-41-toc.gif BMC Family Practice 1471-2296 ${item.volume} 41 2012-05-28T00:00:00Z PDF Background: Insomnia is common in primary care, can persist after co-morbid conditions are treated, and may require long-term medication treatment. A potential alternative to medications is cognitive behavioral therapy for insomnia (CBT-I). Methods: In accordance with PRISMA guidelines, we systematically reviewed MEDLINE, EMBASE, the Cochrane Central Register, and PsycINFO for randomized controlled trials (RCTs) comparing CBT-I to any prescription or non-prescription medication in patients with primary or comorbid insomnia. Trials had to report quantitative sleep outcomes (e.g. sleep latency) in order to be included in the analysis. Extracted results included quantitative sleep outcomes, as well as psychological outcomes and adverse effects when available. Evidence base quality was assessed using GRADE. Results: Five studies met criteria for analysis. Low to moderate grade evidence suggests CBT-I has superior effectiveness to benzodiazepine and non-benzodiazepine drugs in the long term, while very low grade evidence suggests benzodiazepines are more effective in the short term. Very low grade evidence supports use of CBT-I to improve psychological outcomes. Conclusions: CBT-I is effective for treating insomnia when compared with medications, and its effects may be more durable than medications. Primary care providers should consider CBT-I as a first-line treatment option for insomnia. http://www.biomedcentral.com/1471-2296/13/40 Matthew Mitchell Philip Gehrman Michael Perlis Craig Umscheid BMC Family Practice 2012, null:40 2012-05-25T00:00:00Z doi:10.1186/1471-2296-13-40 /content/figures/1471-2296-13-40-toc.gif BMC Family Practice 1471-2296 ${item.volume} 40 2012-05-25T00:00:00Z PDF Background: The top 3% of frequent attendance in primary care is associated with 15% of all appointmentsin primary care, a fivefold increase in hospital expenditure, and more mental disorder andfunctional somatic symptoms compared to normal attendance. Although often temporary ifthese rates of attendance last more than two years, they may become persistent (persistentfrequent or regular attendance). However, there is no long-term study of the economic impactor clinical characteristics of regular attendance in primary care. Cognitive behaviourformulation and treatment (CBT) for regular attendance as a motivated behaviour may offeran understanding of the development, maintenance and treatment of regular attendance in thecontext of their health problems, cognitive processes and social context. Methods: A case control design will compare the clinical characteristics, patterns of health care use andeconomic costs over the last 10 years of 100 regular attenders ([greater than or equal to]30 appointments with general practitioner [GP] over 2 years) with 100 normal attenders (6-22 appointments withGP over 2 years), from purposefully selected primary care practices with differingorganisation of care and patient demographics. Qualitative interviews with regular attendingpatients and practice staff will explore patient barriers, drivers and experiences ofconsultation, and organisation of care by practices with its challenges. Cognitive behaviourformulation analysed thematically will explore the development, maintenance and therapeuticopportunities for management in regular attenders. The feasibility, acceptability and utility ofCBT for regular attendance will be examined.DiscussionThe health care costs, clinical needs, patient motivation for consultation and organisation ofcare for persistent frequent or regular attendance in primary care will be explored to developtraining and policies for service providers. CBT for regular attendance will be piloted with aview to developing this approach as part of a multifaceted intervention. http://www.biomedcentral.com/1471-2296/13/39 Richard Morriss Joe Kai Christopher Atha Anthony Avery Sara Bayes Matthew Franklin Tracey George Marilyn James Samuel Malins Ruth McDonald Shireen Patel Michelle Stubley Min Yang BMC Family Practice 2012, null:39 2012-05-20T00:00:00Z doi:10.1186/1471-2296-13-39 /content/figures/1471-2296-13-39-toc.gif BMC Family Practice 1471-2296 ${item.volume} 39 2012-05-20T00:00:00Z PDF