Cent Of People Research Articles

Men and eating disorders

Around 10 per cent of people diagnosed with an eating disorder are male. Ian Peate looks at the causes and the needs in this under-diagnosed patient group

Should Dentists be Concerned about the Weight of their Patients?

This opinion paper considers obesity and its relationship to dental practice. Twenty-three per cent of people in England are estimated to be obese, a figure that is predicted to continue rising. It follows that obese patients are frequently encountered in general dental practice. The authors review the links between obesity and dental health, the possible barriers and challenges to providing dental care for obese people, and how these may be overcome. They also report the findings of a London survey investigating the current provision of specialist dental services for obese patients who cannot be treated in a standard dental chair. Services across London were highly variable and in some areas no provision was identified. The implications of the rising prevalence of obesity for service planners and practitioners are also discussed.

Digital Asia-Pacific in the twenty-first century: Promises and perils in the creation of an inclusive knowledge society

Change is accelerating in the Asia-Pacific region, including in rural areas, as it becomes the global economy’s growth driver. In 2010, the region’s developing countries grew at an impressive rate of 8.8 per cent compared to 2.7 per cent for the world’s developed economies. With growth in developed countries expected to continue to sputter at around 2.5 per cent for the greater part of this decade, a new development paradigm is in the making. The “made in Asia, consumed in the West” development model that served it so well in the past is giving way to economic growth that is more inclusive and sustainable, and thus increasingly sourced from within the region. Digital innovation has emerged as a key contributor to this paradigm shift, holding much promise that all peoples will be empowered to contribute more meaningfully to the emerging knowledge society. Three aspects of this digital revolution give us much hope for the future: the promises of the mobile miracle, the broadband revolution, and the social media. The Mobile Mirac le In less than five years, the number of mobile telephone subscriptions in the region more than doubled, rising from around 1.08 billion to 2.53 billion. In East Asia, for example, 83 per cent of people living in rural areas have a mobile phone. This was accompanied by a rise in home-grown mobile phone manufacturers and operators that can now claim to rival the West’s incumbents. Their business model is built on reaching out to the low spending, but huge, consumer base of the region. The result is that, for the first time, we have affordable and truly inclusive mobile telephony reaching all: poor and wealthy, rural and urban dwellers, women and men, youth and the aged.

Symptoms of Parkinson's disease.

Most people with Parkinson's disease (PD) have some non-motor symptoms such as sleep disturbance. Some will have impulse control disorders manifested as pathological gambling, hypersexuality, binge eating or compulsive shopping. Others show lack of initiative, indifference and lack of emotional response. This apathy, which is distinct from depression, has been reported to be present in 70 per cent of people with PD. This study examined 99 non-demented people with PD and found that quality of life was reduced in those with either of these impulse control disorders. The behavioural changes put a strain on relationships, and apathy resulted in a withdrawal from relationships and hobbies. The authors emphasise the need to diagnose and manage complications in a timely manner.

Persistent lipid abnormalities in statin‐treated patients with diabetes mellitus in Europe and Canada: results of the Dyslipidaemia International Study

To assess the prevalence of persistent lipid abnormalities in statin-treated patients with diabetes with and without the metabolic syndrome. This was a cross-sectional study of 22,063 statin-treated outpatients consecutively recruited by clinicians in Canada and 11 European countries. Patient cardiovascular risk factors, risk level, lipid measurements and lipid-modifying medication regimens were recorded. Of the 20,129 subjects who had documented diabetes and/or metabolic syndrome status, 41% had diabetes (of whom 86.8% also had the metabolic syndrome). Of those with diabetes, 48.1% were not at total cholesterol target compared with 58% of those without diabetes. Amongst those with diabetes, 41.6 and 41.3% of those with and without the metabolic syndrome, respectively, were not at their LDL cholesterol goal relative to 54.2% of those with metabolic syndrome and without diabetes, and 52% of those with neither condition. Twenty per cent of people with diabetes but without the metabolic syndrome were not at the optimal HDL cholesterol level compared with 9% of those with neither condition. Of people with diabetes and the metabolic syndrome, 49.9% were not at optimal triglyceride level relative to 13.5% of people with neither diabetes nor the metabolic syndrome. Simvastatin was the most commonly prescribed statin (>45%) and the most common statin potency was 20-40 mg/day (simvastatin equivalent). Approximately 14% of patients were taking ezetimibe alone or in combination with a statin. Despite evidence supporting the benefits of lipid modification and international guideline recommendations, statin-treated patients with diabetes had a high prevalence of persistent lipid abnormalities. There is frequently room to optimize therapy through statin dose up-titration and/or addition of other lipid-modifying therapies.

Access to Protection for ‘Offshore Entry Persons’

In the first months of 2011, over 12 000 refugees streamed into Italy from Libya (by boat) and 800 000 into other neighbouring countries; 41 000 Ivorians fled into Liberia; and Kenya received over 40 000 refugees from Somalia. Conditions for refugees in the host countries are harsh, but indefinite detention of each and every asylum seeker is not practised. Back in the antipodes, a comparatively modest 10 000 asylum seekers arrived by boat over a two year period, mostly from Afghanistan, Iraq and Iran. In response, Australian politicians are resorting to ever-more legally questionable responses as solutions to the politically dreaded 'irregular maritime arrivals,' accompanied by language of 'threat'. So relentless has this rhetoric been that a survey conducted in July 2010 found that 38 per cent of the Australian population believed that irregular maritime arrivals amounted to a tenth of the annual immigration intake, and 10 per cent of people thought it was at least half. The correct figure was 2.9 per cent of the permanent migration and humanitarian programs for 2009-10.

Meeting carers’ needs

In a document published last September, the Department of Health (DH) (2010a) claimed that up to 40 per cent of people in acute hospitals have dementia but that many of the staff who care for them have no specific training in the field.

Meeting carers' needs.

IN A document published last September, the Department of Health (DH) ( 2010a ) claimed that up to 40 per cent of people in acute hospitals have dementia but that many of the staff who care for them have no specific training in the field.

Bringing in care planning conversations for patients whose recovery is uncertain: learning from the AMBER care bundle

60 per cent of people in our inner city area die in an acute hospital. The hospital provides good care to patients known to be dying through the Liverpool Care...

On-farm Study of Human Contact Networks to Document Potential Pathways for Avian Influenza Transmission between Commercial Poultry Farms in Ontario, Canada

Human movements associated with poultry farming create contact networks that might facilitate transmission of avian influenza (AI) between farms during outbreaks. In Canada, no information is available about how these networks connect poultry farms. The purpose of this study was to document human contacts between commercial poultry farms in Ontario, Canada, to learn how AI might be transmitted during outbreaks. We used face-to-face interviews with people entering the farm biosecurity perimeter on four layer, one turkey and three broiler breeder poultry farms in Ontario to collect information on between-farm contacts and biosecurity practices. Over a four-day study period on each farm, a median of 10.5 people entered the farm biosecurity perimeter (range 2-31). Ninety-six per cent (111/118) of people consented to be interviewed. Of these, fifty-three per cent (59/111) had contact with one or more (median 2, degree range 1-14) other poultry farms within 72 h. A median of 25 (range 7-65) human contacts linked study farms to other poultry farms. The mean distance of between-farm contacts was 53 km. Eighty-six per cent of people who answered the biosecurity questions (94/109) reported using one or more biosecurity practices. However, on 7/8 farms, at least one person reported that they did not use any biosecurity practices. Fifty per cent of social visitors used biosecurity, whereas 96% of all other people used biosecurity. Ninety-two per cent of people that entered the poultry barns (46/50) used one or more biosecurity practices, whereas 81% of people (48/59) that did not enter the poultry barns used one or more biosecurity practices. Because our study documented farm visitors who did not use any biosecurity practices and moved between commercial poultry farms, we suggest that rapid trace-out of human movements is as important as containment zoning to limiting disease spread during an outbreak of highly pathogenic AI in Ontario.

Poverty in Edwardian Britain

This article introduces a newly discovered household budget data set for 1904. We use these data to estimate urban poverty among working families in the British Isles. Applying Bowley's poverty line, we estimate that at least 23 per cent of people in urban working households and 18 per cent of working households had income insufficient to meet minimum needs. This is well above Rowntree's estimate of primary poverty for York in 1899 and high in the range that Bowley found in northern towns in 1912–13. The skill gradient of poverty is steep; for instance, among labourers' households, the poverty rates are close to 50 per cent. Measures of the depth of poverty are relatively low in the data, suggesting that most poor male-headed working households were close to meeting Bowley's new standard.

Can a community-based 'smoke-free homes' intervention persuade families to apply smoking restrictions at homes?

Children are commonly exposed to second-hand smoke (SHS). The aim of this study is to evaluate the feasibility, acceptability and outcome of Smoke-Free Homes (SFH), a community-based intervention; and assess potential evaluation methods. SFH, designed to encourage families to implement smoking restrictions at home, was delivered over a period of 6 months through schools, healthcare settings and community events in Beeston, South Leeds, UK. It was evaluated using baseline and post-implementation surveys, focus group discussions and promise forms follow-up. We surveyed 318 households before, and 217 households after, the intervention. The proportion of all surveyed households reporting being completely smoke free significantly increased from 35% [95% confidence interval (CI) 30, 40] at baseline to 68% (95% CI: 61, 74) 6 months post-implementation (P < 0.0001). Ninety per cent of people, followed-up by telephone 3 months after signing SFH promise form, said they were still keeping their promise. Focus group discussions with children and parents conveyed acceptability of the intervention, in particular, the schools element, where children are encouraged to discuss the concept of SFH with the adults in their households. Our study shows that SFH can be implemented effectively and has the potential to improve children's health through preventing exposure to SHS in the home.

Clear up the confusion.

DELIRIUM CAN be a frightening experience. older people, those with dementia, severe illness or hip fracture are at greater risk of delirium. The prevalence of delirium on acute medical wards is up to 30 per cent and between 10 and 50 per cent of people having surgery develop delirium. In care homes the prevalence is 20 per cent.

Ileal disease is associated with surgery for perianal disease in a population-based Crohn's disease cohort

The aim of this study was describe the frequency and characteristics of perianal surgical intervention (PSI) for Crohn's disease in a population-based cohort of patients with inflammatory bowel disease (IBD). A total of 1421 patients with IBD were recruited, representing approximately 91 per cent of people with IBD in Canterbury, New Zealand. The clinical notes were screened to confirm the diagnosis and extract clinical data, including details of PSIs. Some 649 patients with Crohn's disease were included in the analysis, of whom 119 (18.3 per cent) had at least one PSI. Of these, 61 (51.3 per cent) required further procedures. Operations for perianal abscess and fistula accounted for 72.4 per cent of interventions. PSI rates did not differ between the sexes (P = 0.218). Age less than 17 years (adjusted odds ratio (OR) 1.89 (95 per cent confidence interval 1.08 to 3.28)) and ileal disease (OR 1.76 (1.06 to 2.92)) were identified as predictors of PSI. As disease duration increased, so did the proportion of patients with complicated intestinal disease among those who had undergone PSI. The median time to first PSI from diagnosis of Crohn's disease was 28 (interquartile range 7-82) months. Sex, age at diagnosis and disease location did not influence the time to first PSI. PSIs are frequent in patients with Crohn's disease, particularly those with ileal disease and those diagnosed at a young age.

Frequency and characteristics of disease flares in ankylosing spondylitis

Objective. To examine the characteristics and frequency of disease flares in a cohort of people with AS.Methods. A prospective data set from a randomized controlled trial (RCT) of a probiotic treatment/placebo was utilized to examine disease flares in 134 people with AS. Disease flares were defined as either minor/localized flares (pain/swelling localized to one area with fatigue and stiffness) or major/generalized flares (generalized pain, hot burning joints, muscle spasm, fever, sweating, extreme fatigue and stiffness).Results. One hundred and thirty-four people were followed up for 1216 person follow-up weeks and there were 71.4 flares per 100 person-weeks. Of these, 12 were major/generalized flares and 59.4 were minor/localized flares. People who experienced at least one major/generalized flare during the study period had worse disease during flare-free periods in terms of disease activity, impaired function, self-reported night pain and iritis compared with those who did not experience any major/generalized flares during the study. Major/generalized flares lasted for an average of 2.4 weeks (s.d. 2.7), and were preceded by and followed by a minor/localized flare in 92% (55/60) of cases.Conclusion. Seventy per cent of people with AS felt they had a flare in any given week. Those who experienced major/generalized flares appear to have more severe and active disease even during periods when not in flare, compared with those who do not experience major/generalized flares. These results have implications for the timing of assessments prior to starting anti-TNF therapy and suggest that the presence of major flares may be helpful in identifying patients with severe disease.

Pharmaceutical brand substitution in Australia: Identifying factors associated with having multiple brand substitutions

Abstract Objective The aim was to determine the frequency with which people have multiple brand changes for more than one medicine and to identify factors associated with having multiple brand substitutions. Method The setting was the Repatriation Pharmaceutical Benefits Scheme, a national subsidised scheme for medicines supply in Australia. We used a retrospective cohort design using prescription claims data for subsidised medicine dispensings from 1 June 2005 to 31 August 2006. Analysis was limited to patients with the opportunity for brand substitution of two or more medicines. ‘Switches’ were identified for each medicine if different brand or generic products were supplied at consecutive dispensings. Multivariate analysis was conducted to identify factors associated with patients who had multiple switches during follow-up. Key findings A total of 84 040 people were included. On average, they received 11 prescription medicines. Forty-nine per cent of people received the same product throughout follow-up for each medicine and 34% had a single brand substitution. Seventeen per cent had multiple switches for one or more medicine; however, only 3% of all patients had multiple switches for more than one medicine. Independent factors associated with having multiple switches were increasing number of hospital admissions, prescription medicines, co-morbidities, prescribers, dispensing pharmacies and living in an aged-care facility or city. Conclusions Most patients do not have multiple brand substitutions of their medicine, even when all medicine use is considered. This is the first study to identify factors associated with having multiple brand substitutions. Quality use of medicines interventions targeting individuals with these risk factors could minimise the potential for patient confusion as a result of multiple brand changes.

The saddest debate of all

According to the latest poll by The Times, 95 per cent of people now favour assisted suicide for those with a terminal illness. The RCN, however, estimates that its membership is split down the middle, a big factor in its decision to abandon opposition in favour of a neutral stance towards changes in the law. Perhaps it is unsurprising that nurses, who have chosen a profession primarily dedicated to saving lives and enhancing quality of life, are less likely to favour decisions that end life.

Low-cost Insurance Schemes in Scottish Social Housing: An Empirical Study of Availability and Tenants' Participation

The UK has had a long history of market provision of household insurance. Recent years, however, have seen a decline in the traditional insurance market distribution channels aimed at low-income and/or rented-sector households. The products, pricing and method of payment currently offered by insurers have exacerbated the exclusion of many in social housing from this important financial services product. Research suggests that only 50 per cent of people living in rented or local authority housing insure their contents, compared with 93 per cent of homeowners. The aim of this paper is to evaluate the degree to which tenants in public-sector housing participate in low-cost household insurance schemes promoted by their landlord and to assess the reasons behind this level of participation. This study suggests that, despite value-for-money schemes being available, the take-up rates by tenants are low and that the providers of social housing need to be more vigorous and imaginative in their promotion of low-cost insurance schemes if this form of financial exclusion is to be tackled successfully.

Domiciliary and day care services: Why do people with dementia refuse?

Objective: To explore the reasons given for refusal of day services, and to examine the relationship between willingness to accept day services and clinical variables. Method: Fifty people with dementia who lived alone and had refused day services were interviewed. Results: The most common reasons for reluctance to attend day services were the belief that they did not need day services, that they liked being on their own, and the belief that they would not enjoy it. People who persistently refused day services tended to have additional worries about meeting new people, losing their independence and being institutionalised. Fifty-four per cent of people with dementia who lived alone and had refused day services scored six or more on the Cornell Scale for Depression in Dementia, suggesting possible presence of major depression. Conclusion: In patients with dementia who live alone and refuse day services, their misconceptions about day services and possibility of undiagnosed depression need further exploration.

Promoting independent living among people with dementia and sight loss

Abstract The risk of developing multiple chronic illnesses increases rapidly with age. More than 12 per cent of people over the age of 75 are visually impaired and evidence suggests higher rates of sight loss among people with dementia. The combination of cognitive and visual impairment is likely to be an overwhelming experience, profoundly affecting functional ability, activity, mood and sense of identity. Care professionals in residential and community settings require evidence on which to base good practice in this area. This paper presents findings from the first qualitative research project to explore the experiences and needs of older adults with concurrent sight loss and dementia. The study found that individuals experienced a profound sense of disorientation and were highly vulnerable to isolation. The paper highlights the importance of providing this client group with corrective remedies for sight loss, a 'user-friendly' environment, optimal lighting, colour and contrast, assistive technology, cl...