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Moore SE, McEvoy CT, Prior L, Lawton J, Patterson CC, Kee F, Cupples M, Young IS, Appleton K, McKinley MC, Woodside JV. Barriers to adopting a Mediterranean diet in Northern European adults at high risk of developing cardiovascular disease. J Hum Nutr Diet 2017; 31:451-462. [PMID: 29159932 DOI: 10.1111/jhn.12523] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Strong evidence links the consumption of a Mediterranean diet (MD) with a reduced cardiovascular disease (CVD) risk; however, there is uncertainty as to whether non-Mediterranean regions will adopt this diet. The present qualitative research aimed to investigate attitudes towards a MD in individuals at high CVD risk in a Northern European population. This information is needed to inform development of MD interventions in non-Mediterranean high-risk populations. METHODS Focus groups (n = 12) were held with individuals at high CVD risk from Northern Europe (≥2 CVD risk factors, aged ≥50 years, no established CVD/type 2 diabetes). Attitudes to dietary change towards a MD were explored. Data were analysed using inductive thematic analysis. RESULTS Sixty-seven adults participated (60% female, mean age 64 years). There was some awareness of the term MD but limited knowledge of its composition. Barriers to general dietary change were evident, including perception of expense, concern over availability, expectation of time commitment, limited knowledge, lack of cooking skills, amount and conflicting nature of media information on diets, changing established eating habits and resistance to dietary change. Barriers specific to MD adoption were also identified, including perceived difficulty living in a colder climate, perceived impact on body weight, acceptability of a MD and cultural differences. CONCLUSIONS Knowledge of a MD was limited in this Northern European sample at high CVD risk. In addition to general barriers to dietary change, barriers specific to a MD were identified. These findings have implications for the development of interventions aiming to promote MD adoption in non-Mediterranean populations.
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Affiliation(s)
- S E Moore
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - C T McEvoy
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - L Prior
- UK Clinical Research Collaboration Centre of Excellence for Public Health, Queens University Belfast, Belfast, UK
| | - J Lawton
- Centre for Population Health Sciences, University of Edinburgh Medical School, Edinburgh, UK
| | - C C Patterson
- Centre for Public Health, Queen's University Belfast, Belfast, UK.,UK Clinical Research Collaboration Centre of Excellence for Public Health, Queens University Belfast, Belfast, UK
| | - F Kee
- Centre for Public Health, Queen's University Belfast, Belfast, UK.,UK Clinical Research Collaboration Centre of Excellence for Public Health, Queens University Belfast, Belfast, UK
| | - M Cupples
- Centre for Public Health, Queen's University Belfast, Belfast, UK.,UK Clinical Research Collaboration Centre of Excellence for Public Health, Queens University Belfast, Belfast, UK
| | - I S Young
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - K Appleton
- Department of Psychology, Bournemouth University, Bournemouth, UK
| | - M C McKinley
- Centre for Public Health, Queen's University Belfast, Belfast, UK.,UK Clinical Research Collaboration Centre of Excellence for Public Health, Queens University Belfast, Belfast, UK
| | - J V Woodside
- Centre for Public Health, Queen's University Belfast, Belfast, UK.,UK Clinical Research Collaboration Centre of Excellence for Public Health, Queens University Belfast, Belfast, UK
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McAleer SF, Cupples ME, Neville CE, McKinley MC, Woodside JV, Tully MA. Statin prescription initiation and lifestyle behaviour: a primary care cohort study. BMC Fam Pract 2016; 17:77. [PMID: 27430618 PMCID: PMC4950708 DOI: 10.1186/s12875-016-0471-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 06/08/2016] [Indexed: 11/10/2022]
Abstract
Background Statin prescribing and healthy lifestyles contribute to declining cardiovascular disease mortality. Recent guidelines emphasise the importance of giving lifestyle advice in association with prescribing statins but adherence to healthy lifestyle recommendations is sub-optimal. However, little is known about any change in patients’ lifestyle behaviours when starting statins or of their recall of receiving advice. This study aimed to examine patients’ diet and physical activity (PA) behaviours and their recall of lifestyle advice following initiation of statin prescribing in primary care. Method In 12 general practices, patients with a recent initial prescription of statin therapy, were invited to participate. Those who agreed received a food diary by post, to record food consumed over 4 consecutive days and return to the researcher. We also telephoned participants to administer brief validated questionnaires to assess typical daily diet (DINE) and PA level (Godin). Using the same methods, food diaries and questionnaires were repeated 3 months later. At both times participants were asked if they had changed their behaviour or received advice about their diet or PA. Results Of 384 invited, 122 (32 %) participated; 109 (89.3 %) completed paired datasets; 50 (45.9 %) were male; their mean age was 64 years. 53.2 % (58/109) recalled receiving lifestyle advice. Of those who did, 69.0 % (40/58) reported having changed their diet or PA, compared to 31.4 % (16/51) of those who did not recall receiving advice. Initial mean daily saturated fat intake (12.9 % (SD3.5) of total energy) was higher than recommended; mean fibre intake (13.8 g/day (SD5.5)), fruit/vegetable consumption (2.7 portions/day (SD1.3)) and PA levels (Godin score 7.1 (SD13.9)) were low. Overall, although some individuals showed evidence of behaviour change, there were no significant changes in the proportions who reported high or medium fat intake (42.2 % v 49.5 %), low fibre (51.4 % v 55.0 %), or insufficient PA (80.7 % v 83.5 %) at 3-month follow-up. Conclusion Whilst approximately half of our cohort recalled receiving lifestyle advice associated with statin prescribing this did not translate into significant changes in diet or PA. Further research is needed to explore gaps between people’s knowledge and behaviours and determine how best to provide advice that supports behaviour change. Electronic supplementary material The online version of this article (doi:10.1186/s12875-016-0471-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S F McAleer
- Centre for Public Health, Institute of Clinical Sciences Block B, Royal Victoria Hospital, Queen's University Belfast, Grosvenor Road, Belfast, BT12 6BA, UK
| | - M E Cupples
- Centre for Public Health, Institute of Clinical Sciences Block B, Royal Victoria Hospital, Queen's University Belfast, Grosvenor Road, Belfast, BT12 6BA, UK. .,UKCRC Centre of Excellence for Public Health Research (NI), Institute of Clinical Sciences Block B, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, UK. .,Department of General Practice and Primary Care, Queen's University, Belfast, UK.
| | - C E Neville
- Centre for Public Health, Institute of Clinical Sciences Block B, Royal Victoria Hospital, Queen's University Belfast, Grosvenor Road, Belfast, BT12 6BA, UK
| | - M C McKinley
- Centre for Public Health, Institute of Clinical Sciences Block B, Royal Victoria Hospital, Queen's University Belfast, Grosvenor Road, Belfast, BT12 6BA, UK.,UKCRC Centre of Excellence for Public Health Research (NI), Institute of Clinical Sciences Block B, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, UK
| | - J V Woodside
- Centre for Public Health, Institute of Clinical Sciences Block B, Royal Victoria Hospital, Queen's University Belfast, Grosvenor Road, Belfast, BT12 6BA, UK.,UKCRC Centre of Excellence for Public Health Research (NI), Institute of Clinical Sciences Block B, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, UK
| | - M A Tully
- Centre for Public Health, Institute of Clinical Sciences Block B, Royal Victoria Hospital, Queen's University Belfast, Grosvenor Road, Belfast, BT12 6BA, UK.,UKCRC Centre of Excellence for Public Health Research (NI), Institute of Clinical Sciences Block B, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, UK.,Department of General Practice and Primary Care, Queen's University, Belfast, UK
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3
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Murphy AW, Cupples ME, Murphy E, Newell J, Scarrott CJ, Vellinga A, Gillespie P, Byrne M, Kearney C, Smith SM. Six-year follow-up of the SPHERE RCT: secondary prevention of heart disease in general practice. BMJ Open 2015; 5:e007807. [PMID: 26534729 PMCID: PMC4636612 DOI: 10.1136/bmjopen-2015-007807] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To determine the long-term effectiveness of a complex intervention in primary care aimed at improving outcomes for patients with coronary heart disease. DESIGN A 6-year follow-up of a cluster randomised controlled trial, which found after 18 months that both total and cardiovascular hospital admissions were significantly reduced in intervention practices (8% absolute reduction). SETTING 48 general practices in the Republic of Ireland and Northern Ireland. PARTICIPANTS 903 patients with established coronary heart disease at baseline in the original trial. INTERVENTION The original intervention consisted of tailored practice and patient plans; training sessions for practitioners in medication prescribing and behavioural change; and regular patient recall system. Control practices provided usual care. Following the intervention period, all supports from the research team to intervention practices ceased. PRIMARY OUTCOME hospital admissions, all cause and cardiovascular; secondary outcomes: mortality; blood pressure and cholesterol control. RESULTS At 6-year follow-up, data were collected from practice records of 696 patients (77%). For those who had died, we censored their data at the point of death and cause of death was established. There were no significant differences between the intervention and control practices in either total (OR 0.83 (95% CI 0.54 to 1.28)) or cardiovascular hospital admissions (OR 0.91 (95% CI 0.49 to 1.65)). We confirmed mortality status of 886 of the original 903 patients (98%). There were no significant differences in mortality (15% in intervention and 16% in control) or in the proportions of patients above target control for systolic blood pressure or total cholesterol. CONCLUSIONS Initial significant differences in the numbers of total and cardiovascular hospital admissions were not maintained at 6 years and no differences were found in mortality or blood pressure and cholesterol control. Policymakers need to continue to assess the effectiveness of previously efficacious programmes. TRIAL REGISTRATION NUMBER Current Controlled Trials ISRCTN24081411.
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Affiliation(s)
- A W Murphy
- Discipline of General Practice, National University of Ireland, Galway, Ireland
| | - M E Cupples
- UKCRC Centre of Excellence for Public Health (Northern Ireland), Queen's University Belfast, Belfast, Northern Ireland
| | - E Murphy
- Discipline of General Practice, National University of Ireland, Galway, Ireland
| | - J Newell
- Health Research Board Clinical Research Facility, National University of Ireland, Galway, Ireland
| | - C J Scarrott
- School of Mathematic and Statistics, University of Canterbury, Christchurch, New Zealand
| | - A Vellinga
- Discipline of General Practice, National University of Ireland, Galway, Ireland
| | - P Gillespie
- School of Business and Economics, National University of Ireland, Galway, Ireland
| | - M Byrne
- School of Psychology, National University of Ireland, Galway, Ireland
| | - C Kearney
- Discipline of General Practice, National University of Ireland, Galway, Ireland
| | - S M Smith
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
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Pogosova N, Saner H, Pedersen SS, Cupples ME, Mc Gee H, Hofer S, Doyle F, Schmid JP, VON Kanel On Behalf Of The Cardiac Rehabilitation Section Of The European Association Of Cardiovascular Prevention And Rehabilitation Of The European Society Of Cardiology R. [Psychosocial Aspects in Cardiac Rehabilitation: From Theory to Practice. A Position Paper From the Cardiac Rehabilitation Section of The European Association of Cardiovascular Prevention and Rehabilitation of the European Society of Cardiology]. Kardiologiia 2015; 55:96-108. [PMID: 28294802 DOI: 10.18565/cardio.2015.10.96-108] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A large body of empirical research shows that psychosocial risk factors (PSRFs) such as low socio-economic status, social isolation, stress, type-D personality, depression and anxiety increase the risk of incident coronary heart disease (CHD) and also contribute to poorer health-related quality of life (HRQoL) and prognosis in patients with establishedCHD. PSRFs may also act as barriers to lifestyle changes and treatment adherence and may moderate the effects of cardiac rehabilitation (CR). Furthermore, there appears to be a bidirectional interaction between PSRFs and the cardiovascular system. Stress, anxiety and depression affect the cardiovascular system through immune, neuroendocrine and behavioural pathways. In turn, CHD and its associated treatments may lead to distress in patients, including anxiety and depression. In clinical practice, PSRFs can be assessed with single-item screening questions, standardised questionnaires, or structured clinical interviews. Psychotherapy and medication can be considered to alleviate any PSRF-related symptoms and to enhance HRQoL, but the evidence for a definite beneficial effect on cardiac endpoints is inconclusive. A multimodal behavioural intervention, integrating counselling for PSRFs and coping with illness should be included within comprehensive CR. Patients with clinically significant symptoms of distress should be referred for psychological counselling or psychologically focused interventions and/or psychopharmacological treatment. To conclude, the success of CR may critically depend on the interdependence of the body and mind and this interaction needs to be reflected through the assessment and management of PSRFs in line with robust scientific evidence, by trained staff, integrated within the core CR team.
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Affiliation(s)
- N Pogosova
- 1Federal Health Center and Department of Internal Disease Prevention, National Research Center for Preventive Medicine, Russia; 2Cardiovascular Prevention, Rehabilitation and Sports Medicine, Bern University Hospital, Switzerland; 3Department of Psychology, University of Southern Denmark, Denmark; 4Department of Cardiology, Odense University Hospital, Denmark; 5UKCRC Centre of Excellence for Public Health (Northern Ireland), Queens University, Belfast, UK; 6Division of Population Health Sciences (Psychology), Royal College of Surgeons in Ireland, Ireland; 7Medical Psychology, Innsbruck Medical University, Austria; 8Cardiology Clinic, Tiefenauspital, Bern University Hospital, Switzerland; 9Department of Neurology, Bern University Hospital, Switzerland; 10Department of Psychosomatic Medicine, Clinic Barmelweid, Barmelweid, Switzerland
| | - H Saner
- 1Federal Health Center and Department of Internal Disease Prevention, National Research Center for Preventive Medicine, Russia; 2Cardiovascular Prevention, Rehabilitation and Sports Medicine, Bern University Hospital, Switzerland; 3Department of Psychology, University of Southern Denmark, Denmark; 4Department of Cardiology, Odense University Hospital, Denmark; 5UKCRC Centre of Excellence for Public Health (Northern Ireland), Queens University, Belfast, UK; 6Division of Population Health Sciences (Psychology), Royal College of Surgeons in Ireland, Ireland; 7Medical Psychology, Innsbruck Medical University, Austria; 8Cardiology Clinic, Tiefenauspital, Bern University Hospital, Switzerland; 9Department of Neurology, Bern University Hospital, Switzerland; 10Department of Psychosomatic Medicine, Clinic Barmelweid, Barmelweid, Switzerland
| | - S S Pedersen
- 1Federal Health Center and Department of Internal Disease Prevention, National Research Center for Preventive Medicine, Russia; 2Cardiovascular Prevention, Rehabilitation and Sports Medicine, Bern University Hospital, Switzerland; 3Department of Psychology, University of Southern Denmark, Denmark; 4Department of Cardiology, Odense University Hospital, Denmark; 5UKCRC Centre of Excellence for Public Health (Northern Ireland), Queens University, Belfast, UK; 6Division of Population Health Sciences (Psychology), Royal College of Surgeons in Ireland, Ireland; 7Medical Psychology, Innsbruck Medical University, Austria; 8Cardiology Clinic, Tiefenauspital, Bern University Hospital, Switzerland; 9Department of Neurology, Bern University Hospital, Switzerland; 10Department of Psychosomatic Medicine, Clinic Barmelweid, Barmelweid, Switzerland
| | - M E Cupples
- 1Federal Health Center and Department of Internal Disease Prevention, National Research Center for Preventive Medicine, Russia; 2Cardiovascular Prevention, Rehabilitation and Sports Medicine, Bern University Hospital, Switzerland; 3Department of Psychology, University of Southern Denmark, Denmark; 4Department of Cardiology, Odense University Hospital, Denmark; 5UKCRC Centre of Excellence for Public Health (Northern Ireland), Queens University, Belfast, UK; 6Division of Population Health Sciences (Psychology), Royal College of Surgeons in Ireland, Ireland; 7Medical Psychology, Innsbruck Medical University, Austria; 8Cardiology Clinic, Tiefenauspital, Bern University Hospital, Switzerland; 9Department of Neurology, Bern University Hospital, Switzerland; 10Department of Psychosomatic Medicine, Clinic Barmelweid, Barmelweid, Switzerland
| | - H Mc Gee
- 1Federal Health Center and Department of Internal Disease Prevention, National Research Center for Preventive Medicine, Russia; 2Cardiovascular Prevention, Rehabilitation and Sports Medicine, Bern University Hospital, Switzerland; 3Department of Psychology, University of Southern Denmark, Denmark; 4Department of Cardiology, Odense University Hospital, Denmark; 5UKCRC Centre of Excellence for Public Health (Northern Ireland), Queens University, Belfast, UK; 6Division of Population Health Sciences (Psychology), Royal College of Surgeons in Ireland, Ireland; 7Medical Psychology, Innsbruck Medical University, Austria; 8Cardiology Clinic, Tiefenauspital, Bern University Hospital, Switzerland; 9Department of Neurology, Bern University Hospital, Switzerland; 10Department of Psychosomatic Medicine, Clinic Barmelweid, Barmelweid, Switzerland
| | - S Hofer
- 1Federal Health Center and Department of Internal Disease Prevention, National Research Center for Preventive Medicine, Russia; 2Cardiovascular Prevention, Rehabilitation and Sports Medicine, Bern University Hospital, Switzerland; 3Department of Psychology, University of Southern Denmark, Denmark; 4Department of Cardiology, Odense University Hospital, Denmark; 5UKCRC Centre of Excellence for Public Health (Northern Ireland), Queens University, Belfast, UK; 6Division of Population Health Sciences (Psychology), Royal College of Surgeons in Ireland, Ireland; 7Medical Psychology, Innsbruck Medical University, Austria; 8Cardiology Clinic, Tiefenauspital, Bern University Hospital, Switzerland; 9Department of Neurology, Bern University Hospital, Switzerland; 10Department of Psychosomatic Medicine, Clinic Barmelweid, Barmelweid, Switzerland
| | - F Doyle
- 1Federal Health Center and Department of Internal Disease Prevention, National Research Center for Preventive Medicine, Russia; 2Cardiovascular Prevention, Rehabilitation and Sports Medicine, Bern University Hospital, Switzerland; 3Department of Psychology, University of Southern Denmark, Denmark; 4Department of Cardiology, Odense University Hospital, Denmark; 5UKCRC Centre of Excellence for Public Health (Northern Ireland), Queens University, Belfast, UK; 6Division of Population Health Sciences (Psychology), Royal College of Surgeons in Ireland, Ireland; 7Medical Psychology, Innsbruck Medical University, Austria; 8Cardiology Clinic, Tiefenauspital, Bern University Hospital, Switzerland; 9Department of Neurology, Bern University Hospital, Switzerland; 10Department of Psychosomatic Medicine, Clinic Barmelweid, Barmelweid, Switzerland
| | - J -P Schmid
- 1Federal Health Center and Department of Internal Disease Prevention, National Research Center for Preventive Medicine, Russia; 2Cardiovascular Prevention, Rehabilitation and Sports Medicine, Bern University Hospital, Switzerland; 3Department of Psychology, University of Southern Denmark, Denmark; 4Department of Cardiology, Odense University Hospital, Denmark; 5UKCRC Centre of Excellence for Public Health (Northern Ireland), Queens University, Belfast, UK; 6Division of Population Health Sciences (Psychology), Royal College of Surgeons in Ireland, Ireland; 7Medical Psychology, Innsbruck Medical University, Austria; 8Cardiology Clinic, Tiefenauspital, Bern University Hospital, Switzerland; 9Department of Neurology, Bern University Hospital, Switzerland; 10Department of Psychosomatic Medicine, Clinic Barmelweid, Barmelweid, Switzerland
| | - R VON Kanel On Behalf Of The Cardiac Rehabilitation Section Of The European Association Of Cardiovascular Prevention And Rehabilitation Of The European Society Of Cardiology
- 1Federal Health Center and Department of Internal Disease Prevention, National Research Center for Preventive Medicine, Russia; 2Cardiovascular Prevention, Rehabilitation and Sports Medicine, Bern University Hospital, Switzerland; 3Department of Psychology, University of Southern Denmark, Denmark; 4Department of Cardiology, Odense University Hospital, Denmark; 5UKCRC Centre of Excellence for Public Health (Northern Ireland), Queens University, Belfast, UK; 6Division of Population Health Sciences (Psychology), Royal College of Surgeons in Ireland, Ireland; 7Medical Psychology, Innsbruck Medical University, Austria; 8Cardiology Clinic, Tiefenauspital, Bern University Hospital, Switzerland; 9Department of Neurology, Bern University Hospital, Switzerland; 10Department of Psychosomatic Medicine, Clinic Barmelweid, Barmelweid, Switzerland
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Allen-Walker V, Woodside J, Holmes V, Young I, Cupples ME, Hunter A, McKinley MC. Routine weighing of women during pregnancy-is it time to change current practice? BJOG 2015; 123:871-4. [DOI: 10.1111/1471-0528.13511] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2015] [Indexed: 11/28/2022]
Affiliation(s)
- V Allen-Walker
- Centre for Public Health; School of Medicine; Dentistry & Biomedical Science; Queen's University Belfast; Belfast UK
| | - J Woodside
- Centre for Public Health; School of Medicine; Dentistry & Biomedical Science; Queen's University Belfast; Belfast UK
- Affiliation to UKCRC Centre of Excellence for Public Health (Northern Ireland); School of Medicine; Dentistry & Biomedical Science; Queen's University Belfast; Belfast UK
| | - V Holmes
- Centre for Public Health; School of Medicine; Dentistry & Biomedical Science; Queen's University Belfast; Belfast UK
| | - I Young
- Centre for Public Health; School of Medicine; Dentistry & Biomedical Science; Queen's University Belfast; Belfast UK
- Affiliation to UKCRC Centre of Excellence for Public Health (Northern Ireland); School of Medicine; Dentistry & Biomedical Science; Queen's University Belfast; Belfast UK
| | - ME Cupples
- Centre for Public Health; School of Medicine; Dentistry & Biomedical Science; Queen's University Belfast; Belfast UK
- Affiliation to UKCRC Centre of Excellence for Public Health (Northern Ireland); School of Medicine; Dentistry & Biomedical Science; Queen's University Belfast; Belfast UK
| | - A Hunter
- Royal Jubilee Maternity Services; Belfast Health & Social Care Trust; Belfast UK
| | - MC McKinley
- Centre for Public Health; School of Medicine; Dentistry & Biomedical Science; Queen's University Belfast; Belfast UK
- Affiliation to UKCRC Centre of Excellence for Public Health (Northern Ireland); School of Medicine; Dentistry & Biomedical Science; Queen's University Belfast; Belfast UK
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Prior L, Scott D, Hunter R, Donnelly M, Tully MA, Cupples ME, Kee F. Exploring lay views on physical activity and their implications for public health policy. A case study from East Belfast. Soc Sci Med 2014; 114:73-80. [PMID: 24911510 DOI: 10.1016/j.socscimed.2014.05.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 05/05/2014] [Accepted: 05/09/2014] [Indexed: 10/25/2022]
Abstract
It is now recognised that inactive lifestyles underpin much of the disease burden evident in the richer nations of the world. Indeed, the WHO has identified physical inactivity as a 'global public health problem' and has established minimum physical activity (PA) targets for people at different stages of the life-course. Yet, according to WHO, just under 1/3 of working age adults across the globe meet those targets and it is not at all clear how the disjunction between the recommendations of policy makers and the behaviour of ordinary people might be surmounted. Using an opportunity to examine the impact of an urban regeneration project on community residents in East Belfast (Northern Ireland) this paper examines the views of some 113 people on how to increase rates of PA in an area of multiple deprivation. The results of the analysis suggest that lay people rarely consider PA as a discrete issue, or one that centres on individuals and their motivation, but rather as one component in a complex web of concerns, processes and events that include such things as the actions of neighbours and relatives, material and political environments, vandalism, violence, and the weather. We explore and unravel the nature of those concerns using novel methods of content analysis that generate 'issue webs'. Particular attention is paid to the ways in which lay people conceptualize 'activity' and to the manner in which they point to ways of encouraging activity that are rooted in everyday life rather than in the corpocentric, agent-centred and often sport dominated strategies favoured by local policy makers. Our results support those who argue that interventions to increase rates of PA need to move beyond behavioural approaches that focus on individuals and consider the social, political and material contexts in which 'activity' occurs.
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Affiliation(s)
- L Prior
- UKCRC Center of Excellence for Public Health Research (Northern Ireland), Queen's University, Belfast BT7 1NN, UK; School of Sociology, Social Policy & Social Work, Queen's University, Belfast BT7 1NN, UK.
| | - D Scott
- UKCRC Center of Excellence for Public Health Research (Northern Ireland), Queen's University, Belfast BT7 1NN, UK; Institute of Clinical Sciences, Block B, Queen's University Belfast, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BA, UK.
| | - R Hunter
- UKCRC Center of Excellence for Public Health Research (Northern Ireland), Queen's University, Belfast BT7 1NN, UK; Institute of Clinical Sciences, Block B, Queen's University Belfast, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BA, UK.
| | - M Donnelly
- UKCRC Center of Excellence for Public Health Research (Northern Ireland), Queen's University, Belfast BT7 1NN, UK; Institute of Clinical Sciences, Block B, Queen's University Belfast, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BA, UK.
| | - M A Tully
- UKCRC Center of Excellence for Public Health Research (Northern Ireland), Queen's University, Belfast BT7 1NN, UK; Institute of Clinical Sciences, Block B, Queen's University Belfast, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BA, UK.
| | - M E Cupples
- UKCRC Center of Excellence for Public Health Research (Northern Ireland), Queen's University, Belfast BT7 1NN, UK; Institute of Clinical Sciences, Block B, Queen's University Belfast, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BA, UK.
| | - F Kee
- UKCRC Center of Excellence for Public Health Research (Northern Ireland), Queen's University, Belfast BT7 1NN, UK; Institute of Clinical Sciences, Block B, Queen's University Belfast, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BA, UK.
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Scott W, Cupples M, Prior L, Hunter R, Tully M, Kee F, Donnelly M. Physical activity in Northern Ireland-not in pole position but still on the grid. J Sci Med Sport 2012. [DOI: 10.1016/j.jsams.2012.11.785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Affiliation(s)
- M E Cupples
- Department of General Practice, Queen's University, Belfast BT9 7HR, UK.
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9
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Affiliation(s)
- P A Cooke
- Department of General Practice, Queen's University, Belfast BT9 7HR, UK.
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10
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Hughes J, Kee F, Bennett K, O'Flaherty M, Critchley J, Cupples M, Capewell S. Modelling coronary heart disease mortality in Northern Ireland between 1987 and 2007. Br J Soc Med 2011. [DOI: 10.1136/jech.2011.143586.21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Cupples ME, Stewart MC, Percy A, Hepper P, Murphy C, Halliday HL. A RCT of peer-mentoring for first-time mothers in socially disadvantaged areas (the MOMENTS Study). Arch Dis Child 2011; 96:252-8. [PMID: 20522466 DOI: 10.1136/adc.2009.167387] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Interventions to reduce health inequalities for young children and their mothers are important: involving peers is recommended, but evidence of value for this approach is limited. The authors aimed to examine the effect of an innovative tailored peer-mentoring programme, based on perceived needs, for first-time mothers in socio-economically deprived communities. DESIGN Randomised controlled trial; parallel qualitative study with purposive samples using semistructured interviews. SETTING Socio-economically disadvantaged areas, Belfast. PARTICIPANTS Primigravidae, aged 16-30 years, without significant co-morbidity. INTERVENTION Peer-mentoring by a lay-worker fortnightly during pregnancy and monthly for the following year, tailored to participants' wishes (home visits/telephone contacts), additional to usual care. MAIN OUTCOME MEASURES Infant psychomotor and mental development (Bayley Scales of Infant Development (BSID-II)) at 1 year, assessed by an observer blinded to group allocation. Mothers' health at 1 year postnatal (SF-36). RESULTS Of 534 women invited, 343(64%) participated; 85%, with their children, completed outcome assessments (140 of 172 intervention; 152 of 171 controls). Intervention and control groups did not differ in BSID-II psychomotor (mean difference 1.64, 95% CI -0.94 to 4.21) or mental (-0.81, -2.78 to 1.16) scores, nor SF-36 physical functioning (-5.4, -11.6 to 0.7) or mental health (-1.8, -6.1 to 2.6). Women valued advice given in context of personal experience of child-rearing. Mentors gained health-related knowledge, personal skills and new employment opportunities. CONCLUSIONS Despite possible longer-term social advantage, this peer-mentoring programme showed no benefit for infant development or maternal health at 1 year. Further rigorous evaluation of important outcomes of complex interventions promoting health for children in socially disadvantaged communities is warranted. TRIAL REGISTRATION NO ISRCTN 55055030.
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Affiliation(s)
- M E Cupples
- Department of General Practice and Primary Care, Queen's University Belfast, Belfast, UK.
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Murphy AW, Cupples ME, Smith SM, Byrne M, Byrne MC, Newell J. Effect of tailored practice and patient care plans on secondary prevention of heart disease in general practice: cluster randomised controlled trial. BMJ 2009; 339:b4220. [PMID: 19875426 PMCID: PMC2770592 DOI: 10.1136/bmj.b4220] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To test the effectiveness of a complex intervention designed, within a theoretical framework, to improve outcomes for patients with coronary heart disease. DESIGN Cluster randomised controlled multicentre trial. SETTING General practices in Northern Ireland and the Republic of Ireland, regions with different healthcare systems. PARTICIPANTS 903 patients with established coronary heart disease registered with one of 48 practices. INTERVENTION Tailored care plans for practices (practice based training in prescribing and behaviour change, administrative support, quarterly newsletter), and tailored care plans for patients (motivational interviewing, goal identification, and target setting for lifestyle change) with reviews every four months at the practices. Control practices provided usual care. MAIN OUTCOME MEASURES The proportion of patients at 18 month follow-up above target levels for blood pressure and total cholesterol concentration, and those admitted to hospital, and changes in physical and mental health status (SF-12). RESULTS At baseline the numbers (proportions) of patients above the recommended limits were: systolic blood pressure greater than 140 mm Hg (305/899; 33.9%, 95% confidence interval 30.8% to 33.9%), diastolic blood pressure greater than 90 mm Hg (111/901; 12.3%, 10.2% to 14.5%), and total cholesterol concentration greater than 5 mmol/l (188/860; 20.8%, 19.1% to 24.6%). At the 18 month follow-up there were no significant differences between intervention and control groups in the numbers (proportions) of patients above the recommended limits: systolic blood pressure, intervention 98/360 (27.2%) v control, 133/405 (32.8%), odds ratio 1.51 (95% confidence interval 0.99 to 2.30; P=0.06); diastolic blood pressure, intervention 32/360 (8.9%) v control, 40/405 (9.9%), 1.40 (0.75 to 2.64; P=0.29); and total cholesterol concentration, intervention 52/342 (15.2%) v control, 64/391 (16.4%), 1.13 (0.63 to 2.03; P=0.65). The number of patients admitted to hospital over the 18 month study period significantly decreased in the intervention group compared with the control group: 107/415 (25.8%) v 148/435 (34.0%), 1.56 (1.53 to 2.60; P=0.03). CONCLUSIONS Admissions to hospital were significantly reduced after an intensive 18 month intervention to improve outcomes for patients with coronary heart disease, but no other clinical benefits were shown, possibly because of a ceiling effect related to improved management of the disease. TRIAL REGISTRATION Current Controlled Trials ISRCTN24081411.
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Affiliation(s)
- A W Murphy
- Department of General Practice, National University of Ireland Galway, Ireland.
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Cupples BB, Cupples M. Anna Isobel Cupples (nee Pillow). West J Med 2008. [DOI: 10.1136/bmj.a1650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Cupples ME, Byrne MC, Smith SM, Leathem CS, Murphy AW. Secondary prevention of cardiovascular disease in different primary healthcare systems with and without pay-for-performance. Heart 2008; 94:1594-600. [PMID: 18701532 DOI: 10.1136/hrt.2008.145912] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To compare baseline cardiovascular risk management between people from two different healthcare systems recruited to a research trial of an intervention to optimise secondary prevention. DESIGN Cross-sectional study. SETTING 16 randomly selected general practices in Northern Ireland (NI) (UK NHS, strong infrastructure, pay-for-performance) and 32 in the Republic of Ireland (RoI) (mixed healthcare economy, less infrastructure, no pay-for-performance). PATIENTS 903 (mean age 67.5 years; 69.9% male) randomly selected patients with known coronary heart disease. MAIN OUTCOME MEASURES Blood pressure (BP), cholesterol, medications; validated questionnaires for diet (DINE), exercise (Godin) and quality of life (SF-12); healthcare usage. RESULTS More RoI than NI participants had systolic BP >140 mm Hg (37% vs 28%, p = 0.01) and cholesterol >5 mmol/l (24% vs 17%, p = 0.02). RoI mean systolic BP was higher (139 vs 132 mm Hg). More RoI participants reported a high fibre intake (35% vs 23%), higher levels of physical activity (62% vs 44%) and better physical and mental health (SF-12); they also had more GP (5.6 vs 4.4) and fewer nurse visits (1.6 vs 2.1) in the previous year. Fewer participants in the RoI (55% vs 70%) were prescribed beta blockers. ACE inhibitor prescribing was similar for both groups (41%; 48%); high proportions were prescribed statins (84%; 85%) and aspirin (83%; 77%). CONCLUSIONS BP and cholesterol are better controlled among patients in a primary healthcare system with a strong infrastructure supporting computerisation and rewarding measured performance, but this is not associated with healthier lifestyle or better quality of life. Further exploration of differences in professionals' and patients' engagement in secondary prevention in different healthcare systems is needed.
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Affiliation(s)
- M E Cupples
- Public Health Medicine and Primary Care, Queen's University, Belfast, UK.
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Tully MA, Cupples ME, Chan WS, McGlade K, Young IS. Brisk walking, fitness, and cardiovascular risk: a randomized controlled trial in primary care. Prev Med 2005; 41:622-8. [PMID: 15917061 DOI: 10.1016/j.ypmed.2004.11.030] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2004] [Revised: 07/05/2004] [Accepted: 11/24/2004] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVE To examine the effects of 30 min of self-paced, non-supervised, brisk walking, 5 days per week on the health and fitness of people aged 50-65 years. DESIGN Randomized controlled trial. Members of the intervention group (n = 21) were directed to walk briskly for 30 min, 5 days per week, for 12 weeks. Individuals were given the choice to complete the 30 min of walking in one session or in shorter bouts of no less than 10 min. They were asked to record in a diary the time spent walking and the number of steps taken during a single walk using a pedometer. Participants in the control group (n = 10) were asked to maintain their habitual lifestyle and not change their activity or dietary habits. Measurements of body mass index (BMI), waist/hip ratio (WHR), blood pressure, functional capacity, total cholesterol, triglyceride, and lipoprotein subfractions were taken before and after the program. Changes in 10-year risk estimate for coronary heart disease and stroke were calculated using Framingham risk equations. SETTING Three urban general practices patients: 31 healthy, sedentary 50- to 65-year-old participants recruited following contact by their general practitioner. MAIN RESULTS The mean time spent walking by the intervention group was 27.72 (+/-9.79) min/day: their adherence to the protocol was 90.3%. Significant decreases in systolic and diastolic blood pressure, reduction in stroke risk, and increased functional capacity were found within the walking group between baseline and 12-week measurements. No changes were found in these parameters within the control group. Significant reductions in 10-year risk of CHD were observed in both groups. No significant changes were found in lipid levels or anthropometric measurements in either group. CONCLUSIONS The study provides evidence for the benefit to fitness and cardiovascular risk of the "30-min brisk walking, 5 days a week" message to people aged 50-65 years who participated in an unsupervised home-based walking program. Further study to overcome the problem of poor recruitment and determine the minimum effective dose of exercise to improve cardiovascular risk prediction scores is required.
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Affiliation(s)
- M A Tully
- Department of General Practice, Queen's University, Dunluce Health Centre, 1 Dunluce Avenue, Belfast BT9 7HR, Ireland.
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Tully MA, Cupples ME, Young IS. Promoting physical activity in primary care: how to get over the hurdles? Ulster Med J 2004; 73:1-3. [PMID: 15244117 PMCID: PMC2475451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Leggett P, Gilliland AEW, Cupples ME, McGlade K, Corbett R, Stevenson M, O'Reilly D, Steele K. A randomized controlled trial using instant photography to diagnose and manage dermatology referrals. Fam Pract 2004; 21:54-6. [PMID: 14760045 DOI: 10.1093/fampra/cmh112] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Fifteen percent of GP consultations are for dermatological conditions; 4% of these are referred to a dermatologist. There are long waiting lists for dermatology appointments. This study examines the value of instant photography in managing dermatology referrals. OBJECTIVE The purpose of our study was to compare outcomes of referral for dermatology appointments between patients whose referral letters do or do not include instant photograph(s). METHODS Patients (136), referred to a dermatologist by GPs in two urban health centres, were randomly allocated to study and control groups. Instant photographs, taken by the GP, were included in the referral letters. Control group patients were given out-patient appointments in the usual way. The numbers of study group patients needing an appointment for diagnosis or management and with a changed diagnosis after face-to-face consultation were recorded. Waiting time from referral to appointment or management plan was recorded for both groups. RESULTS For 63% of the study group (45/71), a diagnosis and a management plan were made without the patient requiring an appointment. This included 38% (27/71) who, after diagnosis and initial management, needed an appointment and 25% (18/71) who did not. The remainder of the study group (37%; 26/71) required a face-to-face consultation. The mean time for formulation of a management plan for patients without an appointment was 17 days (SD = 11); waiting times for appointments in study and control groups were similar (mean 55 days; SD = 40). CONCLUSIONS Instant photography is helpful in managing dermatology referrals and offers the potential to reduce numbers requiring an out-patient appointment by 25%.
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Affiliation(s)
- P Leggett
- Department of General Practice, Queen's University, Royal Victoria Hospital, Belfast, UK.
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Gawley S, Cupples ME. Smoking in pregnancy--the size of our challenge. Ulster Med J 2002; 71:17-21. [PMID: 12137158 PMCID: PMC2475342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Reducing the prevalence of smoking in pregnancy is a priority target for health care. We administered a semi-structured questionnaire to mothers in an inner city general practice who were given brief anti-smoking advice during routine antenatal care. Of a cohort of 113 mothers, 52(46%) reported smoking at the start of pregnancy. Six(12%) of these 52 smokers reported no change in smoking habit during pregnancy; 24(46%) cut down; 12(23%) stopped; 10(19%) increased their cigarette consumption. Of the 52 smokers, 41(79%) believed smoking was harmful to an unborn baby, yet 30(73%) of these women continued smoking. Almost all recalled having been given anti-smoking advice by the GP and/or hospital. There is an urgent need to identify more effective methods of reducing smoking in pregnancy.
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Affiliation(s)
- S Gawley
- Ulster Hospital Trust, Dundonald, Belfast
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19
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Cupples ME, Gawley S. Measuring work in general practice. Br J Gen Pract 2001; 51:847. [PMID: 11677713 PMCID: PMC1314135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
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20
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Thompson WT, Cupples ME, Sibbett CH, Skan DI, Bradley T. Challenge of culture, conscience, and contract to general practitioners' care of their own health: qualitative study. BMJ 2001; 323:728-31. [PMID: 11576981 PMCID: PMC56892 DOI: 10.1136/bmj.323.7315.728] [Citation(s) in RCA: 99] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To explore general practitioners' perceptions of the effects of their profession and training on their attitudes to illness in themselves and colleagues. DESIGN Qualitative study using focus groups and in depth interviews. SETTING Primary care in Northern Ireland. PARTICIPANTS 27 general practitioners, including six recently appointed principals and six who also practised occupational medicine part time. MAIN OUTCOME MEASURES Participants' views about their own and colleagues' health. RESULTS Participants were concerned about the current level of illness within the profession. They described their need to portray a healthy image to both patients and colleagues. This hindered acknowledgement of personal illness and engaging in health screening. Embarrassment in adopting the role of a patient and concerns about confidentiality also influenced their reactions to personal illness. Doctors' attitudes can impede their access to appropriate health care for themselves, their families, and their colleagues. A sense of conscience towards patients and colleagues and the working arrangements of the practice were cited as reasons for working through illness and expecting colleagues to do likewise. CONCLUSIONS General practitioners perceive that their professional position and training adversely influence their attitudes to illness in themselves and their colleagues. Organisational changes within general practice, including revalidation, must take account of barriers experienced by general practitioners in accessing health care. Medical education and culture should strive to promote appropriate self care among doctors.
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Affiliation(s)
- W T Thompson
- Graduate School of Education, Queen's University of Belfast, Belfast BT7 1HL
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Cupples M, Reilly P, Bradley T, Irvine H. GP opportunities for teenage health promotion. Br J Gen Pract 2000; 50:581. [PMID: 10954951 PMCID: PMC1313765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
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22
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Cupples ME, Bradley T, Irvine H, McCann B, Wilson-Davis K. Motherhood in the teens and twenties: some surprises. Ulster Med J 2000; 69:30-4. [PMID: 10881643 PMCID: PMC2449176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
We report a study of the association of health and social support variables with motherhood in teenagers and older mothers. Both teenage and older mothers reported poorer physical and mental health and fewer and less frequent social contacts than their nulliparous peers. Contrary to expectation, however, older mothers reported less extensive and less adequate social support networks than did teenagers.
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Affiliation(s)
- M E Cupples
- Department of General Practice, Queen's University, Belfast
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McKnight A, Cupples M, Archbold GP. Motivational consulting. Br J Gen Pract 1999; 49:837-8. [PMID: 10885096 PMCID: PMC1313543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
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Cupples ME, McKnight A. Five year follow up of patients at high cardiovascular risk who took part in randomised controlled trial of health promotion. BMJ 1999; 319:687-8. [PMID: 10480826 PMCID: PMC28222 DOI: 10.1136/bmj.319.7211.687] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- M E Cupples
- Department of General Practice, Queen's University, Belfast BT9 7HR.
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Cupples ME, Irvine H, Bradley T, Boohan M, Reilly P, Patterson C. Teenage mothers and their peers: a research challenge. Br J Gen Pract 1998; 48:1685-6. [PMID: 10071404 PMCID: PMC1313246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
Recent reports have highlighted the adverse health experience of teenage mothers. The question of how these mothers' perceptions of their own health status and social networks differ from those of their nulliparous peers is explored in this pilot study, which highlights some practical problems associated with research in this important field.
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Affiliation(s)
- M E Cupples
- Department of General Practice, Queen's University of Belfast
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Gilliland AE, Sinclair H, Cupples ME, McSweeney M, Mac Auley D, O'Dowd TC. Stress and morale in general practice: a comparison of two health care systems. Br J Gen Pract 1998; 48:1663-7. [PMID: 10071399 PMCID: PMC1313241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Poor morale and high levels of stress among general practitioners (GPs) are causing concern. Little research has previously been carried out to study possible differences in morale and stress between GPs working in two different but geographically similar health care systems. AIM To compare perceived levels of stress and morale between GPs working in two different health care systems--one having a state monopoly (Northern Ireland) and the other having mixed private and state funding (Republic of Ireland)--and to look for factors that might help explain any differences in stress levels and morale between the two systems. METHOD Anonymous and confidential questionnaires were sent to all 986 National Health Service (NHS) GPs in Northern Ireland (NI) and a random sample of 900 GPs in the Republic of Ireland (ROI). A common set of core questions on demographic details, partners and work patterns, perceived levels of stress and morale, safety, violence, and complaints were asked. RESULTS Response rates were high in both areas: 91% in NI and 78% in the ROI. GPs in NI had significantly higher stress levels and significantly lower levels of morale than GPs in the ROI. The NI sample expect matters to get worse over the following year. Doctors in the ROI were more likely to be single handed and to work from two sites. Also, more GPs in ROI had fears for their safety and had been the subject of physical violence, but fewer had received complaints and medico-legal actions than in NI. CONCLUSIONS A significant proportion of both groups of doctors report feeling highly stressed but GPs in NI appear more unhappy and have a poorer outlook for the future. It is suggested that the structure, management, and expectations of the NHS have taken a severe toll on its GPs, whereas a system in which doctors have less practice support but more control is good for morale.
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Affiliation(s)
- A E Gilliland
- Department of General Practice, Queen's University Belfast
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Irvine H, Bradley T, Cupples M, Boohan M. The implications of teenage pregnancy and motherhood for primary health care: unresolved issues. Br J Gen Pract 1997; 47:323-6. [PMID: 9219414 PMCID: PMC1313012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Teenage pregnancy and motherhood have implications for several different aspects of primary health care. First, the provision of health education and contraceptive services is obviously relevant to the prevention of unplanned teenage pregnancy. Secondly, appropriate obstetric care should be provided for teenagers, who are at high risk of developing complications in pregnancy and childbirth. Thirdly, and perhaps even more significantly, there is the implication of care required to deal with longer-term adverse health consequences associated with teenage pregnancy. In each of these areas, certain issues remain unresolved. This paper identifies key questions that remain unanswered, including the possibility of long-term adverse physical and psychological health consequences for teenage mothers and their children. The conclusion is that further research addressing these unresolved issues is necessary in order to inform health professionals and allow the implications for primary care to be assessed.
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Affiliation(s)
- H Irvine
- School of Social and Community Sciences, University of Ulster
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O'Neill C, Normand C, Cupples M, McKnight A. Cost effectiveness of personal health education in primary care for people with angina in the greater Belfast area of Northern Ireland. J Epidemiol Community Health 1996; 50:538-40. [PMID: 8944861 PMCID: PMC1060346 DOI: 10.1136/jech.50.5.538] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
STUDY OBJECTIVE To investigate the cost effectiveness of personal health education for angina patients being treated in general practice. DESIGN A randomised controlled trial in which people were randomised to intervention and control groups. All were assessed at the start and end of the study, with details recorded of disease status, coronary heart disease risk factors, and self assessed quality of life. A note was taken of their current use of drugs and over the course of the study their use of all health services. Those in the intervention group had three visits per year from a health visitor, whose brief was discuss ways of living more easily with their disease and in which risks of further events might be reduced. PATIENTS Altogether 688 patents in the Greater Belfast area aged less than 75 years and known to have angina for at least six months. MAIN RESULTS Significant improvements in survival and self assessed quality of life were found between the study and control groups. The intervention was associated with a reduction in drug usage and there was no significant difference between the intervention and control groups in terms of their use of other health services. CONCLUSION Given the improvement in survival and self assessed quality of life and no significant differences in costs to the health service between the two groups, the intervention was deemed to be cost effective.
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Affiliation(s)
- C O'Neill
- Department of Economics, Queen's University of Belfast, Northern Ireland
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O'Neill C, Normand C, Cupples M, McKnight A. A comparison of three measures of perceived distress: results from a study of angina patients in general practice in Northern Ireland. J Epidemiol Community Health 1996; 50:202-6. [PMID: 8762389 PMCID: PMC1060253 DOI: 10.1136/jech.50.2.202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To establish the effect of health education on the level of distress felt by patients with angina and to compare the results obtained using different measures. DESIGN Randomised controlled trial of personal health education given every four months. SETTING Eighteen general practices in the greater Belfast area. SUBJECTS These comprised 688 patients aged less than 75 years and known to have had angina for at least six months: 342 were randomised to receive education and 346 no education. MAIN OUTCOME MEASURES These were the Nottingham health profile (NHP), functional limitation profile (FLP), and a simple categorical scale (SCS). RESULTS The intervention group showed a statistically significant improvement in health relative to the control group in terms of physical mobility and social isolation using the NHP. In terms of overall wellbeing, both the NHP and SCS results showed the intervention group had experienced statistically significant improvements in health relative to the control group. Results obtained using the NHP, FLP, and SCS were found to be correlated regardless of whether weighted or unweighted scores were used. CONCLUSION The intervention produced a significant improvement in health status. Results from different survey instruments were correlated using both weighted and unweighted scores. An SCS was capable of detecting the improvement in health status.
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Affiliation(s)
- C O'Neill
- Department of Economics, Queen's University of Belfast
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Magenis C, Cupples M, Bradley T, Murphy G. Differentiating minor from serious illness in infants. Br J Gen Pract 1995; 45:383-4. [PMID: 7612346 PMCID: PMC1239305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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Cupples ME, McKnight A. Health promotion in general practice. BMJ 1995; 310:868-9. [PMID: 7711634 PMCID: PMC2549228 DOI: 10.1136/bmj.310.6983.868b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Cupples ME, Bradley T, Murphy G, Lundy G. Folic acid prescription in pregnancy. Ulster Med J 1995; 64:31-3. [PMID: 7502398 PMCID: PMC2449073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We resolved to prescribe folic acid supplements for all women who attended this practice during the first twelve weeks of pregnancy. Six months after this decision a prescription was recorded in only 13% of cases: this compared with 18% during the two months immediately following the decision. It was resolved to improve this performance and observations six months later revealed a prescription recorded in 63% of cases. Subsequently a new form for recording an antenatal consultation was devised and six months after its implementation, 100% recording of folate prescription for appropriate cases was observed. It was concluded that these simple audit exercises prompted changes in practice which helped to improve standards of patient care.
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Abstract
591 patients with a history of coronary heart disease had one or more biochemical markers of tobacco smoking measured. 26% were self reported smokers and a further 4% were apparent 'smoking deceivers'. The urinary nicotine metabolite concentration is an excellent marker for tobacco smoking; breath CO would be a suitable alternative for busy clinics. Half the patients were subjected to regular advice on risk factor management but there was no evidence that this contributed effectively to smoking cessation. Overall smoking cessation rate was poor.
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Affiliation(s)
- G P Archbold
- Department of Clinical Chemistry, Belfast City Hospital, Northern Ireland, UK
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Abstract
OBJECTIVE To assess the value of health education for patients with angina in reducing risk factors for cardiovascular disease and lessening the effect of angina on everyday activities. DESIGN Randomised controlled trial of personal health education given every four months. SETTING 18 general practices in the greater Belfast area. SUBJECTS 688 patients aged less than 75 years and known to have had angina for at least six months; 342 randomised to receive education and 346 to no education. MAIN OUTCOME MEASURES Restriction of everyday activities, dietary habit, smoking habit, frequency of physical exercise; blood pressure, body mass index, and serum total cholesterol concentration at entry to trial and after two years. RESULTS 317 in the intervention group and 300 in the control group completed the trial. At the two year review more of the intervention group (140, 44%) reported taking daily physical exercise than the control group (70, 24%). The intervention group also reported eating a healthier diet than the control group and less restriction by angina in any everyday activity. No significant differences were found between the groups in smoking habit, systolic or diastolic blood pressure, cholesterol concentration, or body mass index. CONCLUSION Despite having no significant effect on objective cardiovascular risk factors, personal health education of patients with angina seems to increase exercise and improve dietary habits and is effective in lessening the restriction of everyday activities.
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Affiliation(s)
- M E Cupples
- Department of General Practice, Queen's University of Belfast
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Cupples ME, Irwin WG, McDevitt DG. An epidemiological study of digoxin prescribing in general practice. J R Coll Gen Pract 1986; 36:454-7. [PMID: 3440988 PMCID: PMC1960621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The epidemiology of prescribing long-term digoxin was studied in 241 patients from six group general practices. Each patient was assessed for the initial reason for prescribing digoxin and present clinical status, and the serum digoxin concentration was measured between six and 12 hours after the previous dose.The results show that digoxin was most commonly prescribed for elderly patients; 90% of patients were aged 60 years or more. The reasons for prescribing digoxin were considered adequate in only 55% of the total group; 71% of the patients were judged to be clinically well and 75% of the 95 patients with atrial fibrillation had ventricular rates of less than 90 beats per minute. ;Therapeutic' serum digoxin concentrations (0.8-2.0 ng ml(-1)) were observed in only 48% of patients; the level was sub-therapeutic in 46% and potentially toxic in 6%. No clear-cut relationship was found between clinical well-being and serum digoxin concentration. The type of supervision (whether hospital or general practice) did not affect appropriateness of prescribing, clinical well-being or likelihood of achieving a therapeutic serum digoxin level.This study would suggest the need for critical review of digoxin therapy in all patients who are taking it long-term. In some patients its continuance would appear unnecessary; in others, efficacy may be improved either by dose adjustment or by ensuring compliance. On occasions, particularly in patients with sinus rhythm, measurement of serum digoxin concentrations may prove helpful in this evaluation.
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Irwin WG, Cupples ME. A survey of psychotropic drug prescribing. J R Coll Gen Pract 1986; 36:366-8. [PMID: 3735226 PMCID: PMC1960607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Psychotropic drug prescribing in a group practice was studied retrospectively. Approximately two-thirds of patients considered to have psychosocial problems were being treated with psychotropic drugs. Compared with the remaining patients with psychosocial problems not prescribed psychotropic medication these patients were more likely to be older, to have no children in the household and to have a past history of physical illness but were less likely to have an acute physical problem or to have a social factor contributing to their mental problem. Sedative and antidepressant drugs were prescribed with similar frequency for all age groups but 75% of hypnotic drugs were prescribed for the elderly.The study provides evidence that while a high proportion of patients with psychosocial problems receive a prescription for a psychotropic drug, general practitioners are discriminating in their prescribing.
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Cupples ME. Terminal care. Ulster Med J 1981; 50:62-7. [PMID: 6165126 PMCID: PMC2386045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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