Can we get General Practitioners to Promote Physical Activity? Results of the 10,000 Steps Rockhampton Community-Based Physical Activity Promotion Project

Evidence supporting the efficacy of physical activity promotion in primary care settings has evaluated patient-level changes in physical activity, with little focus on the issue of general practitioner (GP) uptake. The 'GP Strategy' of 10,000 Steps Rockhampton provided an opportunity to explore this issue in the context of a multi-strategy, community-based physical activity intervention project. The 'GP Strategy' was developed in partnership with the Capricornia Division of General Practice. It aimed to: 1) increase GP awareness of the 10,000 Steps project, 2) upskill GPs in brief physical activity counselling techniques, and 3) provide GPs with evidencebased physical activity counselling materials and pedometers. The evaluation, which was guided by the RE-AIM evaluation framework, used a pre-post design, including a GP mailed survey, and collection of process data. Survey response rates were 67% (n=44/66; baseline) and 70% (n=37/53; 14-month follow-up). GP awareness of 10,000 Steps Rockhampton increased from 46% to 97%. 21/23 practices were visited by 10,000 Steps staff and accepted 10,000 Steps posters, brochures, and pedometers. At follow-up, 78% had displayed the poster, 81% were using the brochures, and 70% had loaned pedometers to patients. Despite the very high rate of uptake and use of 10,000 Steps materials, there was no change in the percentage of patients counselled, and relatively few pedometers had been loaned to patients. The results of this trial indicate that it will take more effort to change GP physical activity counselling behaviour, and provide only modest support for use of pedometers in the busy general practice setting. Acknowledgement:This project is supported by a grant from Health Promotion Queensland.

Prevalence of subclinical thyroid dysfunction and its relation to socioeconomic deprivation in the elderly:a community-based cross-sectional survey

Context: Population-based screening has been advocated for subclinical thyroid dysfunction in the elderly because the disorder is perceived to be common, and health benefits may be accrued by detection and treatment. Objective: The objective of the study was to determine the prevalence of subclinical thyroid dysfunction and unidentified overt thyroid dysfunction in an elderly population. Design, Setting, and Participants: A cross-sectional survey of a community sample of participants aged 65 yr and older registered with 20 family practices in the United Kingdom. Exclusions: Exclusions included current therapy for thyroid disease, thyroid surgery, or treatment within 12 months. Outcome Measure: Tests of thyroid function (TSH concentration and free T 4 concentration in all, with measurement of free T3 in those with low TSH) were conducted. Explanatory Variables: These included all current medical diagnoses and drug therapies, age, gender, and socioeconomic deprivation (Index of Multiple Deprivation, 2004) Analysis: Standardized prevalence rates were analyzed. Logistic regression modeling was used to determine factors associated with the presence of subclinical thyroid dysfunction Results: A total of 5960 attended for screening. Using biochemical definitions, 94.2% [95% confidence interval (CI) 93.8-94.6%] were euthyroid. Unidentified overt hyper- and hypothyroidism were uncommon (0.3, 0.4%, respectively). Subclinical hyperthyroidism and hypothyroidism were identified with similar frequency (2.1%, 95% CI 1.8-2.3%; 2.9%, 95% CI 2.6-3.1%, respectively). Subclinical thyroid dysfunction was more common in females (P < 0.001) and with increasing age (P < 0.001). After allowing for comorbidities, concurrent drug therapies, age, and gender, an association between subclinical hyperthyroidism and a composite measure of socioeconomic deprivation remained. Conclusions: Undiagnosed overt thyroid dysfunction is uncommon. The prevalence of subclinical thyroid dysfunction is 5%. We have, for the first time, identified an independent association between the prevalence of subclinical thyroid dysfunction and deprivation that cannot be explained solely by the greater burden of chronic disease and/or consequent drug therapies in the deprived population. Copyright © 2006 by The Endocrine Society.

Community-Based Study of the Association of High Myopia in Children with Ocular and Systemic Disease

Purpose. High myopia in childhood is associated with important ocular and systemic conditions. However in the UK, high myopia in early childhood is not specifically identified in current ophthalmology, optometry, or orthoptic protocols for screening, referral, or investigation. An ongoing study in the West Midlands, UK, is investigating high myopia presenting to community health care clinics with the aim of compiling guidelines for assessment and subsequent referral. Methods. Children with high myopia were identified from community optometric and orthoptic sources and invited for an ophthalmology and optometry examination to ascertain possible ocular or systemic disease. Results. High myopia with no associated ocular or systemic condition was present in 15 (56%) of the children. In seven children (25%), associated ocular problems were found including unrecognized retinal dystrophies and amblyopia. Systemic disorders associated with high myopia were found in five children (19%) and included Sticklers syndrome, Weill-Marchesani syndrome, and homocystinuria. In one child, the diagnosis made before this study was found to be incorrect, and in another child, the results were inconclusive. In two cases, the diagnosis of a systemic condition in the child led to the identification of the disease in at least one relative. Conclusions. There is a high prevalence of ocular and systemic abnormality in young children seen in the community. Optometric and ophthalmologic assessment of children less than 10 years with myopia ≥5 D is likely to identify significant ocular or systemic disease, a proportion of which will respond to medical intervention. Detection and prompt referral of these cases by community health care services may be expected to prolong vision and possibly life expectancy.

Medical error:a discussion of the medical construction of error and suggestions for reforms of medical education to decrease error

Introduction: There is a growing public perception that serious medical error is commonplace and largely tolerated by the medical profession. The Government and medical establishment's response to this perceived epidemic of error has included tighter controls over practising doctors and individual stick-and-carrot reforms of medical practice. Discussion: This paper critically reviews the literature on medical error, professional socialization and medical student education, and suggests that common themes such as uncertainty, necessary fallibility, exclusivity of professional judgement and extensive use of medical networks find their genesis, in part, in aspects of medical education and socialization into medicine. The nature and comparative failure of recent reforms of medical practice and the tension between the individualistic nature of the reforms and the collegiate nature of the medical profession are discussed. Conclusion: A more theoretically informed and longitudinal approach to decreasing medical error might be to address the genesis of medical thinking about error through reforms to the aspects of medical education and professional socialization that help to create and perpetuate the existence of avoidable error, and reinforce medical collusion concerning error. Further changes in the curriculum to emphasize team working, communication skills, evidence-based practice and strategies for managing uncertainty are therefore potentially key components in helping tomorrow's doctors to discuss, cope with and commit fewer medical errors.

Community-based older adults' perceptions of factors that influence successful aging in place

The purpose of this study was to obtain an understanding of older adults' perceptions of independence and the factors that allow them to remain living independently in the community. A questionnaire was mailed to a random sample of 500 community-based older adults. One hundred seventy eight questionnaires were returned (36%). Respondents were asked questions related to independence, self-health rating, functional difficulties, and social supports. Most respondents indicated Mental Health (97%), Physical Health (97%), Control of choices (97%), and Social Support Systems (93%) contributed to maintaining independence in the community. Age, education, fewer chronic health conditions, and a higher self-health rating were found to be significant predictors of actual independence. Family members were identified as the primary source of assistance with advice on major life decisions and financial matters. Findings indicate age, education, health status and the social support of family and friends all play an important role for older adults to live independently in the community. Occupational therapy could be instrumental in extending the health, highest level of independent functioning, and the number of years older adults remain living in the community.

Practice-based film education for children: teaching and learning for creativity, citizenship and participation

Practice-oriented film education aimed at children has been hailed for various reasons: at a personal level, as a means of providing tools for self-expression, for developing creativity and communication skills. And at a social level, it is argued that children must now become competent producers, in addition to critical consumers, of audiovisual content so they can take part in the global public sphere that is arguably emerging. This chapter discusses how the challenges posed by introducing children to filmmaking (i.e. digital video) are being met at three civil associations in Mexico: La Matatena AC, which seeks to enrich the children’s lives by means of the aesthetic experience filmmaking can bring them. Comunicaciòn Comunitaria, concerned with the impact filmmaking can have on the community, preserving cultural memory and enabling participation. And Juguemos a Grabar, with a focus on urban regeneration through the cultural industries.

Curriculum development in a heritage language community-based school: A Qualitative inquiry regarding a Brazilian-Portuguese program in South Florida

This research aimed to describe, understand, and discuss the curriculum development process of a Brazilian-Portuguese heritage language community-based school in South Florida. This study was guided by the following research questions: (a) What roles does this HL community-based school aim to play for its students? This investigation was also related to the subsidiary question: (b) How does this HL community-based school organize its curriculum development process? In order to explore these research questions, I observed and interviewed teachers and coordinators based on a qualitative research approach. I analyzed the interviews’ transcripts, and the program’s website with a central focus of describing and understanding their curriculum development process. Hopefully, the findings will help Brazilian and other HL community schools toward discussing and elaborating their own curriculum development, as well as to look for specific teacher training courses.