La prise en charge de l'hyper- tension artériette par des médecins en formation suit-elle les recommandations actuettes [Are the guidelines for the management of hypertensive patients followed by primary care residents and fellows?]

Numerous international guidelines are published which define how hypertensive patients should be managed. Are these guidelines followed and applicable? We have assessed the quality of management of 225 hypertensive ambulatory patients followed by young fellows in teaching for primary care medicine. The control rate defined by a blood pressure < 140/90 mmHg was 32,4%. In the last three visits, 60% of hypertensive patients had a blood pressure measurement. 79% of blood pressure readings ended with 0 or 5. Blood pressure control was identical whatever the comorbidities. In conclusion, the quality of management of hypertensive patients by in teaching fellow could potentially be improved. The actual recommendations are limited in their application. The control of high risk vascular patients is not better than those with a lower risk.

Physician response to "by-the-way" syndrome in primary care.

BACKGROUND/OBJECTIVE: "By-the-way" syndrome, a new problem raised by the patient at an encounter's closure, is common, but little is known about how physicians respond when it occurs. We analyzed the content of the syndrome, predictors of its appearance, and the physician response. DESIGN/PARTICIPANTS: Cross-sectional study of 92 videotaped encounters in an academic primary care clinic. RESULTS: The syndrome occurred in 39.1% of observed encounters. Its major content was bio-psychosocial (39%), psychosocial (36%), or biomedical (25%), whereas physician responses were mostly biomedical (44%). The physician response was concordant with the patient's question in 61% of encounters if the content of the question was psychosocial, 21% if bio-psychosocial, and 78% if biomedical; 32% of physicians solicited the patient's agenda two times or more in the group without, versus 11% in the group with, the syndrome (P = 0.02). In 22% of the encounters, physicians did not give any answer to the patient's question, particularly (38.5%) if it was of psychosocial content. CONCLUSIONS: "By-the-way" syndrome is mainly bio-psychosocial or psychosocial in content, whereas the physician response is usually biomedical. Asking about the patient's agenda twice or more during the office visit might decrease the appearance of this syndrome.

Ischemic heart disease and primary care: identifying gender-related differences. An observational study

Background: Gender-related differences are seen in multiple aspects of both health and illness. Ischemic heart disease (IHD) is a pathology in which diagnostic, treatment and prognostic differences are seen between sexes, especially in the acute phase and in the hospital setting. The objective of the present study is to analyze whether there are differences between men and women when examining associated cardiovascular risk factors and secondary pharmacological prevention in the primary care setting. Methods: Retrospective descriptive observational study from January to December of 2006, including 1907 patients diagnosed with ischemic heart disease in the city of Lleida, Spain. The clinical data were obtained from computerized medical records and pharmaceutical records of medications dispensed in pharmacies with official prescriptions. Data was analyzed using bivariate descriptive statistical analysis as well as logistic regression. Results: There were no gender-related differences in screening percentages for arterial hypertension, diabetes, obesity, dyslipemia, and smoking. A greater percentage of women were hypertensive, obese and diabetic compared to men. However, men showed a tendency to achieve control targets more easily than women, with no statistically significant differences. In both sexes cardiovascular risk factors control was inadequate, between 10 and 50%. For secondary pharmaceutical prevention, the percentages of prescriptions were greater in men for anticoagulants, beta-blockers, lipid-lowering agents and angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, with age group variations up to 10%. When adjusting by age and specific diagnoses, differences were maintained for anticoagulants and lipid-lowering agents. Conclusion: Screening of cardiovascular risk factors was similar in men and women with IHD. Although a greater percentage of women were hypertensive, diabetic or obese, their management of risk factors tended to be worse than men. Overall, a poor control of cardiovascular risk factors was noted. Taken as a whole, more men were prescribed secondary prevention drugs, with differences varying by age group and IHD diagnosis.

Medication incidents in primary care medicine: protocol of a study by the Swiss Federal Sentinel Reporting System.

BACKGROUND/RATIONALE: Patient safety is a major concern in healthcare systems worldwide. Although most safety research has been conducted in the inpatient setting, evidence indicates that medical errors and adverse events are a threat to patients in the primary care setting as well. Since information about the frequency and outcomes of safety incidents in primary care is required, the goals of this study are to describe the type, frequency, seasonal and regional distribution of medication incidents in primary care in Switzerland and to elucidate possible risk factors for medication incidents. Label="METHODS AND ANALYSIS" ="METHODS"/> <AbstractText STUDY DESIGN AND SETTING: We will conduct a prospective surveillance study to identify cases of medication incidents among primary care patients in Switzerland over the course of the year 2015. PARTICIPANTS: Patients undergoing drug treatment by 167 general practitioners or paediatricians reporting to the Swiss Federal Sentinel Reporting System. INCLUSION CRITERIA: Any erroneous event, as defined by the physician, related to the medication process and interfering with normal treatment course. EXCLUSION CRITERIA: Lack of treatment effect, adverse drug reactions or drug-drug or drug-disease interactions without detectable treatment error. PRIMARY OUTCOME: Medication incidents. RISK FACTORS: Age, gender, polymedication, morbidity, care dependency, hospitalisation. STATISTICAL ANALYSIS: Descriptive statistics to assess type, frequency, seasonal and regional distribution of medication incidents and logistic regression to assess their association with potential risk factors. Estimated sample size: 500 medication incidents. LIMITATIONS: We will take into account under-reporting and selective reporting among others as potential sources of bias or imprecision when interpreting the results. ETHICS AND DISSEMINATION: No formal request was necessary because of fully anonymised data. The results will be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: NCT0229537.

Quality of Disease Management and Risk of Mortality in English Primary Care Practices

OBJECTIVE: To investigate whether better management of chronic conditions by family practices reduces mortality risk. DATA: Two random samples of 5 million patients registered with over 8,000 English family practices followed up for 4 years (2004/5-2007/8). Measures of the quality of disease management for 10 conditions were constructed for each family practice for each year. The outcome measure was an indicator taking the value 1 if the patient died during a specified year, 0 otherwise. STUDY DESIGN: Cross-section and multilevel panel data multiple logistic regressions were estimated. Covariates included age, gender, morbidity, hospitalizations, attributed socio-economic characteristics, and local health care supply measures. PRINCIPAL FINDINGS: Although a composite measure of the quality of disease management for all 10 conditions was significantly associated with lower mortality, only the quality of stroke care was significant when all 10 quality measures were entered in the regression. CONCLUSIONS: The panel data results suggest that a 1 percent improvement in the quality of stroke care could reduce the annual number of deaths in England by 782 [95 percent CI: 423, 1140]. A longer study period may be necessary to detect any mortality impact of better management of other conditions.

Physical Activity and Snus: Is There a Link?

The study aimed at assessing the link between physical activity (PA), sports activity and snus use among young men in Switzerland. Data from the Cohort Study on Substance Use Risk Factors (C-SURF) were used to measure PA with the International Physical Activity Questionnaire and sports activity with a single item. Multivariate logistic regression analysis was conducted to measure the association between snus use, PA and sports activity. Similar models were run for smoking and snuff use. Snus use increased in a dose-response association with PA (high level: OR = 1.72; 95% CI 1.16-2.55) and with individuals exercising once a week or more often (OR = 1.65; 95% CI 1.26-2.16; p < 0.001) or almost every day (OR = 2.27; 95% CI 1.72-3.01; p < 0.001) in separate models. Entered simultaneously, only sports and exercise maintained a basically unchanged significant dose-response relationship, whereas PA became non-significant. A non-significant dose-response relation was found for cigarette smoking and snuff use, indicating that the association with sport is specific to snus and not to tobacco use in general or smokeless tobacco in particular. This study showed that the association between snus use and sports is not specific to Nordic countries.

Objectively measured physical activity and sedentary time in youth: the International children's accelerometry database (ICAD).

BACKGROUND: Physical activity and sedentary behaviour in youth have been reported to vary by sex, age, weight status and country. However, supporting data are often self-reported and/or do not encompass a wide range of ages or geographical locations. This study aimed to describe objectively-measured physical activity and sedentary time patterns in youth. METHODS: The International Children's Accelerometry Database (ICAD) consists of ActiGraph accelerometer data from 20 studies in ten countries, processed using common data reduction procedures. Analyses were conducted on 27,637 participants (2.8-18.4 years) who provided at least three days of valid accelerometer data. Linear regression was used to examine associations between age, sex, weight status, country and physical activity outcomes. RESULTS: Boys were less sedentary and more active than girls at all ages. After 5 years of age there was an average cross-sectional decrease of 4.2 % in total physical activity with each additional year of age, due mainly to lower levels of light-intensity physical activity and greater time spent sedentary. Physical activity did not differ by weight status in the youngest children, but from age seven onwards, overweight/obese participants were less active than their normal weight counterparts. Physical activity varied between samples from different countries, with a 15-20 % difference between the highest and lowest countries at age 9-10 and a 26-28 % difference at age 12-13. CONCLUSIONS: Physical activity differed between samples from different countries, but the associations between demographic characteristics and physical activity were consistently observed. Further research is needed to explore environmental and sociocultural explanations for these differences.

Association of car ownership and physical activity across the spectrum of human development : Modeling the Epidemiologic Transition Study (METS).

BACKGROUND: Variations in physical activity (PA) across nations may be driven by socioeconomic position. As national incomes increase, car ownership becomes within reach of more individuals. This report characterizes associations between car ownership and PA in African-origin populations across 5 sites at different levels of economic development and with different transportation infrastructures: US, Seychelles, Jamaica, South Africa, and Ghana. METHODS: Twenty-five hundred adults, ages 25-45, were enrolled in the study. A total of 2,101 subjects had valid accelerometer-based PA measures (reported as average daily duration of moderate to vigorous PA, MVPA) and complete socioeconomic information. Our primary exposure of interest was whether the household owned a car. We adjusted for socioeconomic position using household income and ownership of common goods. RESULTS: Overall, PA levels did not vary largely between sites, with highest levels in South Africa, lowest in the US. Across all sites, greater PA was consistently associated with male gender, fewer years of education, manual occupations, lower income, and owning fewer material goods. We found heterogeneity across sites in car ownership: after adjustment for confounders, car owners in the US had 24.3 fewer minutes of MVPA compared to non-car owners in the US (20.7 vs. 45.1 minutes/day of MVPA); in the non-US sites, car-owners had an average of 9.7 fewer minutes of MVPA than non-car owners (24.9 vs. 34.6 minutes/day of MVPA). CONCLUSIONS: PA levels are similar across all study sites except Jamaica, despite very different levels of socioeconomic development. Not owning a car in the US is associated with especially high levels of MVPA. As car ownership becomes prevalent in the developing world, strategies to promote alternative forms of active transit may become important.

Constrained Total Energy Expenditure and Metabolic Adaptation to Physical Activity in Adult Humans.

Current obesity prevention strategies recommend increasing daily physical activity, assuming that increased activity will lead to corresponding increases in total energy expenditure and prevent or reverse energy imbalance and weight gain [1-3]. Such Additive total energy expenditure models are supported by exercise intervention and accelerometry studies reporting positive correlations between physical activity and total energy expenditure [4] but are challenged by ecological studies in humans and other species showing that more active populations do not have higher total energy expenditure [5-8]. Here we tested a Constrained total energy expenditure model, in which total energy expenditure increases with physical activity at low activity levels but plateaus at higher activity levels as the body adapts to maintain total energy expenditure within a narrow range. We compared total energy expenditure, measured using doubly labeled water, against physical activity, measured using accelerometry, for a large (n = 332) sample of adults living in five populations [9]. After adjusting for body size and composition, total energy expenditure was positively correlated with physical activity, but the relationship was markedly stronger over the lower range of physical activity. For subjects in the upper range of physical activity, total energy expenditure plateaued, supporting a Constrained total energy expenditure model. Body fat percentage and activity intensity appear to modulate the metabolic response to physical activity. Models of energy balance employed in public health [1-3] should be revised to better reflect the constrained nature of total energy expenditure and the complex effects of physical activity on metabolic physiology.

Effects of physical activity and fitness on the psychological wellbeing of young men and working adults: associations with stress, mental resources, overweight and workability

Background: A positive association has been suggested to exist between physical activity and psychological wellbeing. However, the association between physical fitness, especially muscle fitness and psychological wellbeing, has not yet been fully elucidated. Aims: The objective of the present thesis was to assess the relationship between physical activity and physical fitness with stress symptoms, mental resources and workability among young men and working adults. Subjects and methods: Volunteers of young men (n=831, mean age 25-y (±4.0)), underwent a cardiorespiratory (CRF) and muscle fitness (MFI) test and completed leisure time physical activity (LTPA) and Occupational Stress Questionnaires (OSQ). The participants were divided into tertiles according to LTPA, CRF and MFI. A 12-month exercise intervention evaluated 371 working adults (exercise group, n=338, mean age 45-y (±8.8)); control group, n=33, mean age 41-y (±6.9)).The exercise group underwent a 12-month exercise program followed by a 12-month follow-up. The OSQ, Workability Index (WAI) and CRF were evaluated at baseline and at 4, 8, 12 and 24 months. Results: Physically inactive subjects reported more stress and less available mental resources than the subjects who reported high physical activity levels. Improved physical fitness was associated with less stress and more mental resources among normal weight men, but not in overweight men. After a 12-month exercise intervention, employees in the exercise group increased their physical activity, improved workability, decreased stress symptoms and improved their physical fitness and mental resources. After the follow-up year, workability and stress were improved compared to baseline. Conclusions: In this thesis, good physical fitness was associated with improved psychological wellbeing among young men and working adults.

Social physique anxiety across physical activity settings : a meta-analytical review

The purpose of this meta-analytic investigation was to review the empirical evidence specific to the effect of physical activity context on social physique anxiety (SP A). English language studies were located from computer and manual literature searches. A total of 146 initial studies were coded. Studies included in the meta-analysis presented at least one empirical effect for SPA between physical activity participants (i.e., athletes or exercisers) and non-physical activity participants. The final sample included thirteen studies, yielding 14 effect sizes, with a total sample size of 2846. Studies were coded for mean SPA between physical activity participants and non-physical activity participants. Moderator variables related to demographic and study characteristics were also coded. Using Hunter and Schmidt's (2004) protocol, statistical artifacts were corrected. Results indicate that, practically speaking, those who were physically active reported lower levels of SPA than the comparison group (dcorr = -.12; SDeorr.-=-;22). Consideration of the magnitude of the ES, the SDeorr, and confidence interval suggests that this effect is not statistically significant. While most moderator analyses reiterated this trend, some differences were worth noting. Previous research has identified SPA to be especially salient for females compared to males, however, in the current investigation, the magnitude of the ES' s comparing physical activity participants to the comparison group was similar (deorr = -.24 for females and deorr = -.23 for males). Also, the type of physical activity was investigated, and results showed that athletes reported lower levels of SP A than the comparison group (deorr = -.19, SDeorr = .08), whereas exercisers reported higher levels of SPA than the comparison group (deorr = .13, SDeorr = .22). Results demonstrate support for the dispositional nature of SP A. Consideration of practical significance suggests that those who are involved in physical activity may experience slightly lower levels of SPA than those not reporting physical activity participation. Results potentially offer support for the bi-directionality of the relationship between physical activity and SP A; however, a causality may not be inferred. More information about the type of physical activity (i.e., frequency/nature of exercise behaviour, sport classificationllevel of athletes) may help clarify the role of physical activity contexts on SPA.

Investigative links between cognitive function and moderate-to-vigorous physical activity in elementary physical education

Research has noted both physical and psychosocial benefits when children participate in regular physical activity. Recent studies are indicating that there may also be academic benefits and that students may be more efficient learners with participation in physical activity. This study investigated the influence of acute moderate-to-vigorous physical activity on four cognitive functions: planning, attention, simultaneous processing, and successive processing. Three classes (59 students) were each tested twice using a balanced design (intervention, balance, and control groups). It was found that the intervention group had a large increase in planning abiHty (ES = 1.67) when compared to the balance (ES = .80) and control (ES = -.89) groups. On the three remaining cognitive functions, the intervention group showed effect sizes similar to that of the balance and control groups. These results indicate that improved planning after physical activity may playa role in improving student performance.

Leisure-time physical activity in individuals with osteoporosis : associations with psychological well-being

With approximately 16% of the Canadian population living with osteoporosis, and rates expected to increase (Osteoporosis Canada, 2009), cost-effective treatment modalities that improve bone health and psychological well-being reflect an important public health agenda. Physical activity has been implicated as one non-pharmaceutical mechanism to help improve psychological well-being in the general population (Fox, Stathi, McKenna, & Davis, 2007) and in people diagnosed with osteoporosis (Osteoporosis Canada, 2007). The purpose of this investigation was to determine the association between leisure-time physical activity (LTP A) and well-being in people diagnosed with osteoporosis. A secondary purpose, using Basic Needs Theory (BNT; Deci & Ryan, 2002) was to determine if the fulfillment of three psychological needs (i.e., competence, autonomy and relatedness) mediated the relationship between LTP A and well-being. People diagnosed with osteoporosis (N= 190; Mage = 68.14; SDage = 11.54) were asked to complete a battery of questionnaires assessing L TP A, hedonic and eudaimonic well-being and perceived psychological need satisfaction in physical activity contexts. Bivariate correlations revealed a pattern of negligible (r's -0.02 to 0.35) to small correlations between LTP A and well-being with contextual positive affect (r = 0.24) and subjective vitality (r = 0.22) demonstrating statistical significance (p < .01). Results of the multiple mediation analysis indicated that perceived satisfaction of the three psychological needs mediated the relationship between LTPA and well-being with perceived competence emerging as a unique mediator. As such, LTP A was positively associated with well-being in people who are diagnosed with osteoporosis, and the fulfillment of the three psychological needs may be the mechanism through which this 111 effect is carried. Health promotion specialists and practitioners should encourage patients with osteoporosis to engage in LTP A, and support their needs for competence, autonomy and relatedness. Practical implications for researchers and health promotion specialists are discussed in terms ofthe results of this investigation.

Physical activity of children with developmental coordination disorder in the presence of attention deficit hyperactivity disorder : does gender matter?

Baerg, S., Cairney, J., Hay, J., Rempel, L. and Faught, B.E. (2009). Physical Activity of Children with Developmental Coordination Disorder in the Presence of Attention Deficit Hyperactivity Disorder: Does Gender Matter? Brock University, St. Catharines, Ontario, CANADA. Children with Developmental Coordination Disorder (DCD) have difficulties in motor coordination. Attention-deficit hyperactive disorder (ADHD) is considered the condition most co-morbid with DCD at approximately 50%. Children with DCD are generally less physically active (PA) than their peers, while children with ADHD are often considered more physically active. It is not known if the physical activity patterns of children with DCD-ADHD resemble those of children with primarily DCD or that of their healthy peers. The primary objective of this research was to contrast physical activity patterns between children with DCD, DCD-ADHD, and healthy controls. Since boys are generally reported as more physically active than girls, a secondary objective was to determine if gender moderated the association between groups and physical activity. A sample of males (n=66) and females (n=44) were recruited from the Physical Health Activity Study Team (PHAST) longitudinal study. The Movement Assessment Battery for Children (2nd Ed.) was used to identify probable cases of DCD, and Connor's Revised Parent Rating Scale- Short Version to identify ADHD. Subjects (mean age=12.8±.4 yrs) were allocated to three groups; DCD (n=32), DCD-ADHD (n=30) and control (n=48). Physical activity was monitored for seven days with the Actical® accelerometer (activity count, step count and energy expenditure). Children completed the Participation Questionnaire (PQ) during the in-school session of data collection for the PHAST study. Height, weight and body mass index (BMI) were also determined. Analysis of variance showed significant group differences for activity count (F(2,56)=5.36, p=.007) and PQ (F(2,44 )=6. 71, p=.003) in males, while a significant group difference for step count (F(2,37)=3.55, p=.04) was found in females. Post hoc comparison tests (Tukey) identified significantly lower PQ and activity count between males with OCD and controls (p=.004) and males with DCD-ADHD and controls (p=.003). Conversely, females with DCD-ADHD had significantly more step counts than their controls (p=.01). Analysis of covariance demonstrated a gender by DCD groups negative interaction for males (activity count) (F(2,92):;:3.11, p=.049) and a positive interaction for females (step count) (F(1,92)=4.92, p=.009). Hyperactivity in females with DCD-ADHD appears to contribute to more physical activity, whereas DCD may contribute to decreased activity in males with DCD and DCDADHD. Further research is needed to examine gender differences in physical activity within the context of DCD and ADHD.

A comparison of self-determined motivational experiences between participants and non-participants following the physical activity component of the CATCH Kid Club

The CATCH Kids Club (CKC) is an after-school intervention that has attempted to address the growing obesity and physical inactivity concerns publicized in current literature. Using Self-Determination Theory (SDT: Deci & Ryan, 1985) perspective, this study's main research objective was to assess, while controlling for gender and age, i f there were significant differences between the treatment (CKC program participants) and control (non- eKC) groups on their perceptions of need satisfaction, intrinsic motivation and optimal challenge after four months of participation and after eight months of participation. For this study, data were collected from 79 participants with a mean age of9.3, using the Situational Affective State Questionnaire (SASQ: Mandigo et aI., 2008). In order to determine the common factors present in the data, a principal component analysis was conducted. The analysis resulted in an appropriate three-factor solution, with 14 items loading onto the three factors identified as autonomy, competence and intrinsic motivation. Initially, a multiple analysis of co-variance (MANCOY A) was conducted and found no significant differences or effects (p> 0.05). To further assess the differences between groups, six analyses of co-variance (ANeOY As) were conducted, which also found no significant differences (p >0 .025). These findings suggest that the eKC program is able to maintain the se1fdetermined motivational experiences of its participants, and does not thwart need satisfaction or self-determined motivation through its programming. However, the literature suggests that the CKe program and other P A interventions could be further improved by fostering participants' self-determined motivational experiences, which can lead to the persistence of healthy PA behaviours (Kilpatrick, Hebert & Jacobsen, 2002).