The Impact of Exercising on Pelvic Symptom Severity, Pelvic Floor Muscle Strength, and Diastasis Recti Abdominis After Pregnancy: A Longitudinal Prospective Cohort Study

OBJECTIVE

The objective of this study was to evaluate whether early postpartum exercise is associated with changes in pelvic symptom severity, pelvic floor muscle strength, and diastasis recti abdominis (DRA) from 3 to 12 months postpartum.

METHODS

In this prospective cohort study, 504 participants with and without pelvic symptoms (pelvic girdle pain, stress urinary incontinence, vaginal heaviness) were followed. At 3, 6, 9, and 12 months postpartum, we assessed pelvic symptoms, exercise behavior (by questionnaires), pelvic floor muscle strength (by vaginal palpation), and DRA (by caliper measurement). Based on the 3-months questionnaire, participants were categorized as nonexercisers (n = 105), minimal low-impact exercisers (n = 249), regular low-impact exercisers (n = 117), and high-impact exercisers (n = 32). Between-group differences and within-group changes from 3 to 12 months were calculated using Chi-square tests, Kruskal-Wallis tests, and Friedman analysis of variance.

RESULTS

At 3 months, no differences in symptom prevalence were seen between the groups. Nonexercisers reported higher pelvic girdle pain severity and had weaker pelvic floor muscles. The within-group analysis showed that pelvic girdle pain severity did not change in nonexercisers or high-impact exercisers, but decreased in minimal and regular low-impact exercisers. Stress urinary incontinence increased in nonexercisers from 3 to 12 months, while it remained unchanged in regular low-impact and high-impact exercisers, and decreased in minimal low-impact exercisers. Across all groups, vaginal heaviness and DRA decreased, and pelvic floor strength increased from 3 to 12 months.

CONCLUSION

The study indicates that early low-impact exercising is associated with reduced pelvic girdle pain severity during the first postpartum year. Minimal low-impact exercisers also showed a slight reduction in stress urinary incontinence. Conversely, nonexercisers reported an increase in stress urinary incontinence between 3 and 12 months postpartum.

IMPACT

Physical therapists should encourage women to start with low-impact exercise early after pregnancy.

LAY SUMMARY

This study highlights the positive effects of starting gentle, low-impact exercise early after childbirth to reduce pelvic girdle pain and urinary incontinence.

Menopausal symptoms, exercise practices, and advice received in active women: a multi-country survey of strava app users

The study aimed to identify the prevalence of symptoms, changes in exercise levels, and exercise advice received during the menopausal transition in a large multi-country sample. Using total population sampling, 2.5 percent of female Strava app users (n = 970) from 7 countries completed an online survey between 14 February 2019 and 11 March 2019. The survey discussed menopause status (perimenopausal or postmenopausal), menopausal symptoms, changes to exercise behaviors, and advice received concerning exercise during menopause. Frequencies, chi-square statistics, and linear regressions were used to analyze data. The most commonly reported menopausal symptoms were sexual (18-83 percent) and cognitive/psychological (77-78 percent). 41 percent of women reported no change in exercise behavior since menopause began (46 percent increased and 11 percent decreased behaviors). The majority (88 percent) of women did not receive advice regarding exercise during menopause. Women who received advice were more likely to report an increase in their exercise than those not receiving advice (60 percent vs 46 percent; X2 (df 2, n = 927) = 7.1, p = .03). Exercise behaviors increased the longer it had been since the menopausal onset (X2 (df 8, n = 937) = 77.42, p < .001). The results suggested high menopausal symptom prevalence in active women and a general lack of exercise advice. More women reported higher symptom prevalence and an increase in exercise participation, the longer it had been since menopause onset. Future research should determine whether these increased exercise behaviors are being used as a coping mechanism.

Systematic Review to Inform a World Health Organization (WHO) Clinical Practice Guideline: Benefits and Harms of Structured and Standardized Education or Advice for Chronic Primary low back pain in Adults

PURPOSE

Evaluate benefits and harms of education/advice for chronic primary low back pain (CPLBP) in adults to inform a World Health Organization (WHO) standard clinical guideline.

METHODS

Electronic databases were searched for randomized controlled trials (RCTs) assessing education/advice compared with placebo/sham, usual care, or no intervention (including comparison interventions where the attributable effect of education/advice could be isolated). We conducted meta-analyses and graded the certainty of evidence.

RESULTS

We screened 2514 citations and 86 full text RCTs and included 15 RCTs. Most outcomes were assessed 3 to 6 months post-intervention. Compared with no intervention, education/advice improved pain (10 RCTs, MD = -1.1, 95% CI -1.63 to -0.56), function (10 RCTs, SMD = -0.51, 95% CI -0.89 to -0.12), physical health-related quality of life (HRQoL) (2 RCTs, MD = 24.27, 95% CI 12.93 to 35.61), fear avoidance (5 RCTs, SMD = -1.4, 95% CI -2.51 to -0.29), depression (1 RCT; MD = 2.10, 95% CI 1.05 to 3.15), and self-efficacy (1 RCT; MD = 4.4, 95% CI 2.77 to 6.03). Education/advice conferred less benefit than sham Kinesio taping for improving fear avoidance regarding physical activity (1 RCT, MD = 5.41, 95% CI 0.28 to 10.54). Compared with usual care, education/advice improved pain (1 RCT, MD = -2.10, 95% CI -3.13 to -1.07) and function (1 RCT, MD = -7.80, 95% CI -14.28 to -1.32). There was little or no difference between education/advice and comparisons for other outcomes. For all outcomes, the certainty of evidence was very low.

CONCLUSION

Education/advice in adults with CPLBP was associated with improvements in pain, function, HRQoL, and psychological outcomes, but with very low certainty.

Advice as a Form of Structural Coupling: Intersystem Organizations and Scientific Communication in the Japanese Response to COVID-19

A critical issue in the study of scientific communication from a systems theoretical perspective is its role in multiple intersystem relationships. During COVID-19, politics has adopted scientific findings to inform political decisions. However, science has in response actively coordinated its operations for providing desired stimuli to politics. Luhmann identified advice as a form of structural coupling that links political and scientific systems. Advice is not a monolithic intervention by which one side acts on the other but is rather an interface that enables the two systems to relate through distancing. In this article, I empirically illustrate how the structural coupling of the political system and scientific system through advice manifests itself in an examination of the roles that various organizations (expert meeting and cluster task forces) have played in Japan's response to COVID-19. Through this analysis, I provide a theoretical insight regarding these organizations and a more detailed case analysis of the transformation of certain organizations to re-describe the system theoretical insights of advice in the form of scientific communication between politics and science.

Flexible use of confidence to guide advice requests

Subjective confidence plays an important role in guiding behavior, for example, people typically commit to decisions immediately if high in confidence and seek additional information if not. The present study examines whether people are flexible in their use of confidence, such that the mapping between confidence and behavior is not fixed but can instead vary depending on the specific context. To investigate this proposal, we tested the hypothesis that the seemingly natural relationship between low confidence and requesting advice varies according to whether people know, or do not know, the quality of the advice. Participants made an initial perceptual judgement and then chose between re-sampling evidence or receiving advice from a virtual advisor, before committing to a final decision. The results indicated that, when objective information about advisor reliability was not available, participants selected advice more often when their confidence was high rather than when it was low. This pattern reflects the use of confidence as a feedback proxy to learn about advisor quality: Participants were able to learn about the reliability of advice even in the absence of feedback and subsequently requested more advice from better advisors. In contrast, when participants had prior knowledge about the reliability of advisors, they requested advice more often when their confidence was low, reflecting the use of confidence as a self-monitoring tool signaling that help should be solicited. These findings indicate that people use confidence in a way that is context-dependent and directed towards achieving their current goals.

Physical activity promotion in chiropractic: a systematic review of clinician-based surveys

BACKGROUND

Physical inactivity is a global health pandemic. Allied healthcare providers, including chiropractors, are well placed to integrate individual physical activity (PA) promotion into routine care. A previous systematic review identified that approximately 90% of chiropractors held a positive opinion towards healthier patient lifestyles; however, the extent to which chiropractors promote PA to their patients within routine care is unclear. This systematic review aimed to describe chiropractors' attitudes towards and current practice in advising, counselling, discussing, supporting, or recommending PA to patients.

METHODS

Five databases were searched from inception to December 2021 for cross-sectional surveys that explored PA promotion by chiropractors in practice. We assessed the risk of bias of the included studies with the 'Risk of Bias in Cross-Sectional Surveys of Attitudes and Practices' tool. Descriptive data were extracted, grouping similar survey questions and responses into emerging categories. Chiropractors' views regarding the perceived importance and/or their preparedness to counsel and provide PA or exercise information are reported.

RESULTS

From 661 studies, 15 met the selection criteria. Surveys included 7999 chiropractors primarily from the USA, UK, Australia, and Sweden. All studies were rated as moderate-to-high risk of bias, with methodological weaknesses characterised by inconsistent reporting of missing data, non-representative samples, low response rates (i.e., less than 60%), and unknown validity of survey instruments. Chiropractors frequently recognised the importance of PA promotion, as demonstrated by the proportion of respondents reporting that they: (1) support the importance of providing PA or exercise information and counselling (64% to 100%); (2) are prepared to provide PA or exercise information and/or counselling to patients (91% to 92%,); (3) frequently obtain PA or exercise information from patients (87% to 97%,); 4) frequently discuss PA or exercise and/or provide PA or exercise information to patients (68% to 99%); and 5) frequently provide PA counselling to patients (50% to 81%.).

CONCLUSION

A large majority of practising chiropractors actively engage with PA promotion. However, the results should be interpreted with caution owing to the moderate-to-high risk of bias of the included studies. Forthcoming research initiatives should explore unbiased surveys, further PA education and training as well as capitalising on chiropractors' own PA participation.

Kindness in short supply: Evidence for inadequate prosocial input

In everyday life, people often have opportunities to improve others' lives, whether offering well-intentioned advice or complimenting someone on a job well done. These are opportunities to provide "prosocial input" (information intended to benefit others), including feedback, advice, compliments, and expressions of gratitude. Despite widespread evidence that giving prosocial input can improve the well-being of both givers and recipients, people sometimes hesitate to offer their input. The current paper documents when and why people fail to give prosocial input, noting that potential givers overestimate the costs of doing so (e.g., making recipients uncomfortable) and underestimate the benefits (e.g., being helpful) for at least four psychological reasons. Unfortunately, the reluctance to give prosocial input results in a short supply of kindness.

Diagnostic labels and advice for rotator cuff disease influence perceived need for shoulder surgery: an online randomised experiment

QUESTION

What are the effects of diagnostic labels and advice, and interactions between labels and advice, on perceived need for shoulder surgery for rotator cuff disease?

DESIGN

2×2 factorial online randomised experiment.

PARTICIPANTS

People with shoulder pain.

INTERVENTION

Participants read a scenario describing a patient with rotator cuff disease and were randomised to bursitis label plus guideline-based advice, bursitis label plus treatment recommendation, rotator cuff tear label plus guideline-based advice, and rotator cuff tear label plus treatment recommendation. Guideline-based advice included encouragement to stay active and positive prognostic information. Treatment recommendation stressed that treatment is needed for recovery.

OUTCOME MEASURES

Perceived need for surgery (primary outcome), imaging, an injection, a second opinion and to see a specialist; and perceived seriousness of the condition, recovery expectations, impact on work performance and need to avoid work.

RESULTS

A total of 2,024 responses (99.8% of 2,028 randomised) were analysed. Labelling as bursitis (versus rotator cuff tear) decreased perceived need for surgery (mean effect -0.5 on a 0-to-10 scale, 98.3% CI -0.7 to -0.2), imaging and to see a specialist, and perceived seriousness of the condition and need to avoid work. Guideline-based advice (versus treatment recommendation) decreased perceived need for surgery (mean effect -1.0, 98.3% CI -1.3 to -0.7), imaging, an injection, a second opinion and to see a specialist, and perceived seriousness of the condition and recovery expectations. There was little to no evidence of an advice label interaction for any outcome.

CONCLUSION

Labels and advice influenced perceived need for surgery and other secondary outcomes in people with rotator cuff disease, with larger effects for advice. There was evidence of little or no interaction between labels and advice for any outcome, but the additive effect of labels and advice appeared large for some outcomes (eg, perceived need for imaging and perceived seriousness of the condition).

TRIAL REGISTRATION

ACTRN12621001370897.

Implementing Exercise = Medicine in routine clinical care; needs for an online tool and key decisions for implementation of Exercise = Medicine within two Dutch academic hospitals

Background

There is much evidence to implement physical activity interventions for medical reasons in healthcare settings. However, the prescription of physical activity as a treatment, referring to as ‘Exercise is Medicine’ (E = M) is currently mostly absent in routine hospital care in The Netherlands. To support E = M prescription by clinicians in hospitals, this study aimed: (1) to develop an E = M-tool for physical activity advice and referrals to facilitate the E = M prescription in hospital settings; and (2) to provide an E = M decision guide on key decisions for implementation to prepare for E = M prescription in hospital care.

Methods

A mixed method design was used employing a questionnaire and face-to-face interviews with clinicians, lifestyle coaches and hospital managers, a patient panel and stakeholders to assess the needs regarding an E = M-tool and key decisions for implementation of E = M. Based on the needs assessment, a digital E = M-tool was developed. The key decisions informed the development of an E = M decision guide.

Results

An online supportive tool for E = M was developed for two academic hospitals. Based on the needs assessment, linked to the different patients’ electronic medical records and tailored to the two local settings (University Medical Center Groningen, Amsterdam University Medical Centers). The E = M-tool existed of a tool algorithm, including patient characteristics assessed with a digital questionnaire (age, gender, PA, BMI, medical diagnosis, motivation to change physical activity and preference to discuss physical activity with their doctor) set against norm values. The digital E = M-tool provided an individual E = M-prescription for patients and referral options to local PA interventions in- and outside the hospital. An E = M decision guide was developed to support the implementation of E = M prescription in hospital care.

Conclusions

This study provided insight into E = M-tool development and the E = M decision-making to support E = M prescription and facilitate tailoring towards local E = M treatment options, using strong stakeholder participation. Outcomes may serve as an example for other decision support guides and interventions aimed at E = M implementation.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12911-022-01993-5.

Teletriage-How Remote Advice Provides Better Care

There are veterinary deserts across the country where access to veterinary care is limited. Teletriage allows animal owners in these areas to get expert advice about the time frame for care through convenient, commonly used methods of communication. Teletriage also creates financial benefits for traditional veterinary clinics by increasing scheduling efficiencies. Lastly, teletriage can creates employment opportunities for veterinary nurses without the burden of relocation.

A guide to preprinting for early-career researchers

The use of preprints, research manuscripts shared publicly before completing the traditional peer-review process, is becoming a more common practice among life science researchers. Early-career researchers (ECRs) benefit from posting preprints as they are shareable, citable, and prove productivity. However, preprinting a manuscript involves a discussion among all co-authors, and ECRs are often not the decision-makers. Therefore, ECRs may find themselves in situations where they are interested in depositing a preprint but are unsure how to approach their co-authors or advisor about preprinting. Leveraging our own experiences as ECRs, and feedback from the research community, we have constructed a guide for ECRs who are considering preprinting to enable them to take ownership over the process and to raise awareness about preprinting options. We hope that this guide helps ECRs to initiate conversations about preprinting with co-authors and encourage them to preprint their future research.

Summary: Are you an early-career researcher considering preprinting, but unsure how to approach conversations about the possibility? Here, we discuss preprinting and provide tips to enable you to take ownership over the process.

The errors of experts: When expertise hinders effective provision and seeking of advice and feedback

To be effective, experts need to simultaneously develop others (i.e. provide advice and feedback to novices) and advance their own learning (i.e. seek and incorporate advice and feedback from others). However, expertise, and the state of efficacy associated with it, can inhibit experts from engaging in these activities or doing so effectively. We discuss when and why cognitive entrenchment and reduced perspective taking lead experts to hold misperceptions about others. We then explain how these misperceptions lead experts to provide less helpful advice and feedback to novices and to be less likely to seek and take input from others. We offer insights to overcome these barriers, enhancing experts' ability to provide and propensity to seek advice and feedback.

Lessons learned from radiology mentors

As in any field, radiologists may face a number of challenges as they navigate their early careers. Because with experience comes wisdom, early-career radiologists may find helpful the advice and perspectives of mid- and late-career radiologists. The Society of Abdominal Radiology recognizes the value of this pool of knowledge and experience, prompting the establishment of the Early Career Committee. This group is designed to support early-career radiologists by sharing the experiences and insights of leaders in the field. In this series, the authors interview trailblazers Matthew S. Davenport, MD; Jonathan B. Kruskal, MD, PhD; Katherine E. Maturen, MD, MS; David B. Larson, MD, MBA; and Desiree E. Morgan, MD. This perspective explores a wide range of subjects, including personal values in medicine, the role of teleradiology, diversity of backgrounds in radiology, how to navigate workplace conflict, and lifelong learning in medicine. Beyond conveying these pearls of wisdom, the aim of this perspective is to highlight for early-career radiologists the value that mid- and late-career mentors can provide in navigating careers in medicine.

The advice given by physiotherapists to people with back pain in primary care

BACKGROUND

Back pain guidelines endorse giving advice to enable people to self-manage and continue normal activities. Little is known however, about the content of advice that clinicians give and this project aimed to identify the advice given by clinicians to patients with back pain at their initial consultation.

METHODS

A secondary analysis was conducted with 25 audio-recordings and transcriptions of consultations between patients with back pain and physiotherapists in a primary care outpatients department. Using a Framework approach, the data were coded and analysed to identify the content of advice given and mode of delivery.

RESULTS

The mean duration of consultation was 38 min 59 s (range 26:21-53:16). Advice was given in 88% (n = 22/25) of consultations and 96% included additional exercise instruction. Cognitive reassurance was evident, focussing on getting people confident to 'move your back' despite pain and encouraging active lifestyle changes. Beyond reassurance and discussion to enhance confidence, the key topics of advice given were: activity promotion; postural changes; practical self-help advice regarding ways to sit; pain-management advice including medication and using heat. Gaps were identified in the advice given, most notably there was a lack of specificity relating to the frequency and duration of recommended tasks and activities.

CONCLUSIONS

Advice and reassurance are integral to enabling people to self-manage their back pain. It is important to avoid contradictory and unhelpful messages. Despite its importance, little is known about the advice offered by clinicians during initial back pain consultations highlighting the need for guidance to be patient-centred and tailored.

Advice and education provide small short-term improvements in pain and disability in people with non-specific spinal pain: a systematic review

QUESTIONS

What is the effect of advice/education compared with placebo or no advice/education on pain and disability in people with non-specific spinal pain? To what extent do characteristics of the patients, trial or intervention modify the estimate of the treatment effects?

DESIGN

A systematic review with meta-analyses of randomised controlled trials.

PARTICIPANTS

Adults with non-specific back and/or neck pain with or without radiating leg/arm pain of any duration were included. Trials recruiting pregnant women or surgical patients in the immediate postoperative phase were ineligible.

INTERVENTION

Advice or education.

OUTCOME MEASURES

The primary outcomes were self-reported pain and disability, and the secondary outcome was adverse events. The following potential effect modifiers were examined: risk of bias, duration of pain, location of pain, intensity of intervention and mode of intervention.

RESULTS

Twenty-seven trials involving 7,006 participants were included. Eighteen of the included trials were assessed as being at low risk of bias (≥ 6 on the PEDro scale). There was low-quality evidence that advice had a small effect on pain (MD -8.2, 95% CI -12.5 to -3.9, n = 2,241) and moderate-quality evidence that advice had a small effect on disability (MD -4.5, 95% CI -7.9 to -1.0, n = 2,579) compared with no advice or placebo advice in the short-term. None of the items that were assessed modified the treatment effects.

CONCLUSION

Advice provides short-term improvements in pain and disability in non-specific spinal pain, but the effects are small and may be insufficient as the sole treatment for patients with spinal pain.

REGISTRATION

PROSPERO CRD42020162008.

[Support for innovation at the BfArM-experiences from the consultations on digital health applications (DiGA)]

Seit Mai 2020 können Hersteller einen Antrag zur Aufnahme einer digitalen Gesundheitsanwendung (DiGA) in das Verzeichnis nach § 139e Fünftes Buch Sozialgesetzbuch (SGB V) beim für das Bewertungsverfahren zuständigen Bundesinstitut für Arzneimittel und Medizinprodukte (BfArM) stellen. Diesem neuen Antragsverfahren liegen spezifische Anforderungen und Bewertungsparameter zugrunde, zu denen sich herstellerseitig eine Vielzahl an Verfahrens- und wissenschaftlichen Fragestellungen an das BfArM ergibt.

Um diesem Bedarf Rechnung zu tragen, hat das BfArM seine etablierten Informations- und Beratungsangebote gezielt für diese neuen Fragestellungen erweitert. Welche dies bezogen auf DiGA im Einzelnen sind, wo entsprechende Informationen und Unterlagen zu finden sind und was diese jeweils auszeichnet, wird in diesem Beitrag dargelegt. Des Weiteren wird mit Blick auf die zwischen Mai 2020 und April 2021 durchgeführten Beratungsgespräche analysiert, welchen Einfluss diese auf das Ergebnis im jeweiligen Antragsverfahren zur Aufnahme in das DiGA-Verzeichnis haben. Dabei bestätigt sich, dass die frühzeitige Erörterung bewertungsrelevanter Parameter und die Berücksichtigung der Beratungsempfehlungen mit einem positiven Bewertungsergebnis korrelieren: Zu den im Verzeichnis gelisteten DiGA hatten 80 % der Hersteller zuvor eine Beratung durch das BfArM in Anspruch genommen. Die Quote zurückgezogener bzw. abgelehnter Anträge war dagegen deutlich höher, wenn Hersteller zuvor keine Beratung in Anspruch genommen hatten, gegenüber Herstellern, die im Vorfeld zentrale Aspekte mit dem BfArM diskutiert hatten (63 % vs. 35 %). Insgesamt profitieren alle Seiten von dem frühzeitigen, intensiven Austausch – letztendlich insbesondere die Patientinnen und Patienten durch einen unverzögerten Einzug von DiGA in die Regelversorgung aufgrund höherer Antragsqualität.

HIV Disclosure-Professional Body Guidelines, the Law and the Boundaries of Medical Advice

This article examines the current BHIVA/BASHH guidelines on the disclosure of HIV+ status in the context of sexual activity. It assesses whether the guidance provided on how to avoid criminal prosecution accurately reflects the prevailing position in law. Given that aspects of the guidance related to non-disclosure of HIV infection in the context of low or negligible risk are as yet untested in UK law, it is argued that there is some uncertainty as to whether the professional body guidelines and the law can be reconciled with each other. The article also considers whether the BHIVA/BASHH guidelines stray beyond the boundaries of medical advice as normally understood (focused on the protection of health and the prevention of onward transmission), by posing both as legal advice on how to avoid prosecution and offering what could be viewed as a moral judgement as to when disclosure is required. While a bio-medical assessment of risk naturally shapes clinical guidelines and may also inform views as to appropriate sexual behaviour and risk-taking, it is unclear whether scientific assessment of risk should be the sole guide when it comes to determining the nature of any disclosure obligation or the medical advice to be given on this matter.

Effects of advice on experienced-based learning in adolescents and adults

Recent studies that compared effects of pre-learning advice on experience-based learning in adolescents and adults have yielded mixed results. Previous studies on this topic used choice tasks in which age-related differences in advice-related learning bias and exploratory choice behavior are difficult to dissociate. Moreover, these studies did not examine whether effects of advice depend on working memory load. In this preregistered study (in adolescents [13-15 years old] and adults [18-31 years old]), we addressed these issues by factorially combining advice and working memory load manipulations in an estimation task that does not require choices and hence eliminates the influence of known age-related differences in exploration. We found that advice guided participants' initial estimates in both age groups. When advice was correct, this improved estimation performance, especially in adolescents when working memory load was high. When advice was incorrect, it had a longer-lasting effect on adolescents' performance than on adults' performance. In contrast to previous findings in choice tasks, we found no evidence that advice biased learning in either age group. Taken together, our results suggest that learning in an estimation task improves between adolescence and adulthood but that the effects of advice on learning do not differ substantially between adolescents and adults.

Negative stance towards treatment in psychosocial assessments: The role of personalised recommendations in promoting acceptance

People presenting to the emergency department with self-harm or thoughts of suicide undergo a psychosocial assessment involving recommendations for e.g. contact with other practitioners, charity helplines or coping strategies. In these assessments, patients frequently adopt a negative stance towards potential recommendations. Analysing 35 video-recorded liaison psychiatry psychosocial assessments from an emergency department in England (2018-2019), we ask how these practitioners transform this negative stance into acceptance. We show that practitioners use three steps to anticipate and address negative stance (1) asking questions about the patient's experience/understanding that help the patient to articulate a negative stance (e.g., "what do you think about that"); (2) accepting or validating the reasons underlying the negative stance (e.g., "that's a very real fear and thought to have"); and (3) showing the patient that their reasons were incorporated in the recommendation (e.g., "it's telephone support if you're a bit more uncomfortable with face to face"). These steps personalise the recommendation based on the patient's specific experiences and understanding. When practitioners followed all three of these steps, the patient moved from a negative stance to acceptance in 84% of cases. When practitioners made a recommendation but did not follow all three steps, the patient moved from a negative stance to acceptance in only 14% of cases. It is not the case that each communication practice works on its own to promote patient acceptance, rather Steps 1 and 2 build on each other sequentially to develop and demonstrate shared understanding of the patient's negative stance. In this way, acceptance and validation play an indispensable role in addressing a patient's concerns about treatment.

Don't give up when communication is difficult: Online well-being advice for caregivers of people with Alzheimer's and dementia

Sixteen million people in the United States are unpaid caregivers to people with Alzheimer's or dementia. Although caregiver investment is associated with personal and relational benefits, there are also emotional, mental, relational, and physical costs. This study explores online well-being advice for nonprofessional caregivers of people with Alzheimer's and dementia, resulting in 332 online resources that offer informational support for nonprofessional caregivers. Although competent communication directly impacts the well-being of caregiving relationships, only 39 of these texts offered advice related to communication strategies. Thematic analysis of these 39 sources resulted in 1,024 discrete pieces of caregiver advice related to three overarching themes: Daily Routine, Care Recipient Well-Being, and Caregiver Self-Care. We examine the Caregiver Self-Care theme to understand informational support available to caregivers. These self-care advice themes reveal a need for intentional focus on the home health quality of nonprofessional caregivers about ways that communication impacts their everyday lives.

A simulated patient study to evaluate community pharmacist assessment, management and advice giving to patients with asthma

BACKGROUND

Research has shown that there is an increase in the global prevalence of asthma. Pharmacists are well positioned to screen and refer patients for better management of asthma. This study aimed to evaluate community pharmacists' ability to assess the 3 C's (Control, Compliance, Complications) and offer Management and Advice for patients with asthma in the UAE.

METHODS

Three fifth year pharmacy students role played a mystery shopper visiting community pharmacies and requesting symptom relief from uncontrolled asthma. Incidence of cough syrup and reliever inhaler supply, physician referral rate, correction of inhaler technique, and counseling on the medications, adherence to the medications and adverse drug reactions were calculated.

RESULTS

One hundred, ninety five pharmacies were visited, 27% of pharmacists asked about the need for cough syrup and 60% asked about the need for albuterol inhaler. Only 26% asked about other medications. Less than 20% assessed inhaler technique, only one pharmacist asked about regular use of preventer medications and if the patient was adhering to them and only 16% asked about side effects from medications. Most pharmacists (67%) supplied at least one of the medications, while 65% referred the patient to a physician. Only 21% gave information about correct inhaler technique, the majority (> 60%) being incomplete, only 16 pharmacists gave information about asthma and its triggers; the majority (63%) being incomplete. One third of the pharmacists counselled the patient on the medications with one giving complete information.

CONCLUSIONS

The study highlighted suboptimal assessment of control, compliance to preventer medications and complications of asthma and the medications that treat it. It also highlighted suboptimal Management and Advice giving and counseling on medication use by pharmacists. Training pharmacists in all aspects of asthma handling is clearly indicated. Despite the high rate of correct patient referral to a physician noted in this study, there is risk to it, as patients might not actually go to see their physician and continue to depend on symptom relief for the management of their asthma. This study highlighted the importance of improving patient education and information seeking attitude.

An investigation of the information provided to the parents of young people with mental health needs on an internet forum

BACKGROUND

Access to Children and Adolescent Mental Health Services (CAMHS) can be difficult, with lengthy wait times. Many of the young people and their parents are not signposted to any form of support during their wait for initial assessment or treatment and people are increasingly turning towards web-based resources for help and advice. However, there are some concerns about the quality of the information shared online. Research on the use and quality of information shared on online platforms for mental health inquiries is limited.

AIMS

We aimed to investigate the content and quality of the responses shared by forum users on an online forum for parents of young people with mental health needs (Mumsnet 'Talk'). Forum users were primarily parents, but 8 posts were written by posters identifying as a healthcare worker, teacher, or autism spectrum specialist.

METHODS

Qualitative methodology was adopted for this study. Forum content from Mumsnet was extracted in an anonymised form and thematic analysis was conducted to explore the content. Information shared in the online forum was assessed for quality by comparing the responses with clinical guidelines.

RESULTS

Thread topics related to 16 mental health problems. "Autistic Traits/Autism Spectrum Disorder", "Obsessions and Intrusive Thoughts/ Obsessive Compulsive Disorder" and "Comorbid Anxiety and Depression" were the most prevalent thread topics, consisting 38.3% of the extracted content. The investigation focused on "Information Offered" as the general dimension. Based on the thematic analysis, there were four second-order themes regarding the information offered by forum users; referral, advice, anecdotal information and opinion on case. The quantitative assessment of responses found that 58.3% of the knowledge exchange on Mumsnet was congruent with evidence-based clinical guidelines.

CONCLUSIONS

Themes indicate that parents of children and young people with mental health needs seem to use online fora for informational support. It is promising that a significant proportion of the information shared within the extracted forum content is congruent with evidence-based knowledge. However, further investigation is needed to generate better understanding of the overall quality of mental health information available on online platforms.

Five things I wish I had known when I became a consultant

PURPOSE

To report the advice consultants wish they had received on their appointment and to see if that advice differs by gender, or length of time since appointment.

METHODS

An anonymous survey of consultants was undertaken through the alumni offices of the Royal College of Surgeons in Ireland, the Royal College of Physicians of Ireland and the College of Anaesthesiologists of Ireland. A link to a Qualtrics survey was sent and consultants were asked to list the five pieces of advice they wish they had been told on appointment. Free text boxes without limits were used. The responses were analysed and themes identified and subjected to statistical analysis.

RESULTS

A total of 379 consultants responded. The top five pieces of advice were, in order, self-care, work-life balance, relationships with colleagues, teamwork and continuous education. There was a majority of male respondents (60%) and just over 60% of respondents had more than ten years' experience as a consultant. Gender analysis showed that only one of the top five categories-continuous education-demonstrated a significant difference between male and female respondents (p < .001). Self-care was significantly less likely (p < .04) to feature as advice given in those more than twenty years a consultant. Females were significantly more likely to advise learning to 'say no' than males (p < .001). More males had responses in relation to 'financial advice' (p = .002) and 'teaching' (p = .04) compared to females.

CONCLUSION

The emergence of 'self-care' and 'work-life balance' as the top pieces of advice suggests that consultants regret that they have not looked after their health. The fact that 'self-care' was significantly less likely to feature among consultants more than twenty years in practice may point to generational differences.

"You Are Not Alone": Advice Giving for Parents of Children Living with Complex Chronic Conditions

Parental advice giving serves as an important form of informational support for parents of children living with complex chronic conditions (CCCs). These messages can provide backchannel insights into social challenges, best practices, and may offer different forms of experiential wisdom garnered from their own parental caregiving experiences. Contributing to the naturalistic, health-context investigations of advice messages, we interviewed 35 parents who discussed their experiences with parenting their medically complex child. Part of the broader interview protocol asked parents about advice they would offer to other parents like them. We conducted a thematic analysis of parents' responses to these questions to understand advice content, form of advice giving messages, challenges experienced by parents, and suggested best practices for managing a child's CCC. We present our findings and discuss implications on educating health care professionals about how to cultivate advice networks and the need for more parent peer mentoring programs.

Increasing dietary fibre intake in healthy adults using personalised dietary advice compared with general advice: a single-blind randomised controlled trial

Objective:

A high-fibre diet is associated with a lower risk for diseases. However, few adults meet the dietary fibre recommendation. Therefore, the effects and acceptance of an algorithm-generated personalised dietary advice (PDA) compared with general advice (GA) on fibre intake were investigated.

Design:

A 6-week, single-blind randomised controlled trial with a 3-month follow-up.

Setting:

PDA was based on habitual intake and provided fibre-rich alternatives using a website; GA contained brochures. Dietary intake was assessed at baseline, week 1, week 6 and 3-month follow-up. Both groups evaluated their advice at week 6. All participants had access to PDA from week 7 until 3-month follow-up.

Participants:

Two groups of healthy adults: PDA (n 34) and GA (n 47). For 3-month follow-up analysis, participants were re-divided into visitors (n 52) and non-visitors (n 26) of the PDA.

Results:

At week 6, energy intake remained stable in both groups, but fibre intake per 1000 kcal increased non-significantly in both groups (PDA = Δ0·5 ± 2·8; GA = Δ0·8 ± 3·1, P = 0·128). Importantly, a significantly higher percentage of PDA participants adhered to the recommendation compared with week 1 (PDA = 21 % increase; GA = 4 % increase, P ≤ 0·001). PDA participants evaluated the advice significantly better compared with GA participants. At 3-month follow-up, fibre intake increased compared with baseline (visitors = Δ2·2 ± 2·6, P < 0·001; non-visitors = Δ1·5 ± 1·9, P = 0·001), but was insignificantly different between groups. Visitors had a decrease and non-visitors had an increase in energy intake (visitors =Δ − 132 ± 525; non-visitors = Δ109 ± 507, P = 0·055).

Conclusions:

The algorithm-generated PDA was well accepted and stimulated adherence to the recommendations more than GA, indicating to be a suitable and cost-efficient method for improving dietary fibre intake in healthy adults.

Perception of peer advice in online health communities: Access to lay expertise

When seeking advice online about health concerns, forums dedicated to medical themes are increasingly becoming an appreciated source of information for many individuals. In online health communities, patients can ask questions or otherwise seek advice that is particularly relevant to them. While they may find some of the advice useful, other advice may be perceived as less valuable. By studying the advice-seeking, advice-giving, and advice-evaluation behaviours in one of the largest online health communities in Europe, this paper looks at what determines which advice is perceived as helpful, and why. Drawing on network theory, we analysed the interaction data of 108,569 users over twelve consecutive years based on all publicly available information of an established Q&A online health community. Utilising zero-inflated negative binominal modelling, our results show that advice received from others, who have similar predominant interests, is valued more when reaching out for lay expertise. If this advice is given by peers, who can also draw on expertise from other health areas, allowing for a combination of diverse "lay" expertise, the advice is valued even more. Advice provided by those who are quick to obtain the latest knowledge available in the larger community further reinforces these effects. Our findings offer an original view to understand the influence of lay expertise exchanged via online health communities and hold implications for both policy-makers and medical practitioners regarding their approach to patient-initiated use of social media for health-related reasons.

Leaving Against Medical Advice After Emergency General Surgery: Avoiding a Two-Hit Effect

BACKGROUND

Emergency general surgery has higher adverse outcomes than elective surgery. Patients leaving the hospital against medical advice (AMA) have a greater risk for readmission and complications. We sought to identify clinical and demographic characteristics along with hospital factors associated with leaving AMA after EGS operations.

METHODS

A retrospective review of the Nationwide Inpatient Sample was performed. All patients who underwent an EGS procedure accounting for >80% of the burden of EGS-related inpatient resources were identified. 4:1 propensity score analysis was conducted. Regression analyses determined predictive factors for leaving AMA.

RESULTS

546,856 patients were identified. 1085 (0.2%) patients who underwent EGS left AMA. They were more likely to be men (59% versus 42%), younger (median age 51 y, IQR [37.61] versus 54, IQR [38.69]), qualify for Medicaid (26% versus 13%) or be self-pay (17% versus 9%), and be within the lowest quartile median household income (40% versus 28%) (all P < 0.05). After applying 4:1 propensity score matching, individuals who were self-pay (OR 3.15, 95% CI 2.44-4.06) or insured through Medicare (OR 2.75, 95% CI 2.11-3.57) and Medicaid (OR 3.58, 95% CI 2.83-4.52) had increased odds of leaving AMA compared with privately insured patients. In addition, history of alcohol (OR 2.21, 95% CI 1.65-2.98), drug abuse (OR 4.54, 95% CI 3.23-6.38), and psychosis (OR 2.31, 95% CI 1.65-3.23) were associated with higher likelihood for leaving AMA.

CONCLUSIONS

Patients undergoing EGS have a high risk of complications, and leaving AMA further increases this risk. Interventions to encourage safe discharge encompassing surgical, psychiatric, and socioeconomic factors are warranted to prevent a two-hit effect and compound postoperative risk.

Patient resistance towards clinicians' diagnostic test-taking advice and its management in Chinese outpatient clinic interaction

Performing diagnostic tests is a fundamental information-gathering activity in diagnostic process. However, little attention has been paid to the interactional process where a diagnostic test is advised and received, especially in Chinese medical settings. Decision making over prescribing diagnostic tests consists of clinicians' advice and patients' acceptance or resistance/rejection. Drawing on audio-recordings of clinician-patient encounters in Chinese outpatient clinics as data and conversation analysis as a method, we discuss how patient resistance to clinicians' diagnostic test-taking advice is displayed and managed over sequences of interaction. Two types of advice deliveries have been identified: advice either with no diagnostic utterances or with indeterminate diagnostic utterances. We find that patients demonstrate their resistance towards the former type of advice in two ways: questioning clinicians' decisions and proposing an alternative plan. Displaying resistance to the latter type of advice, patients have been found to recurrently resort to one way: proffering additional information about personal experience. Confronted with resistance, clinicians generally proceed to justify decisions by either asserting their epistemic primacy in determining a test or lowering certainty in the original speculative diagnosis. Towards persistent resistance, clinicians mainly employ two techniques to impose acceptance onto patients: repeating the initial advice and terminating forcefully current sequence. This study adds to a growing body of research on resistance in medical settings and contributes to our understanding of the decision making over medical investigations in Chinese outpatient clinic interaction.

Improving Lifestyle Behaviors After Breast Cancer Treatment Among African American Women With and Without Diabetes: Role of Health Care Professionals

BACKGROUND

Little is known about the effect of health professionals' advice on promoting healthy lifestyle behaviors (diet and exercise) among breast cancer patients.

PURPOSE

To identify predictors of receiving lifestyle advice from health professionals and its impact on healthy lifestyle behaviors.

METHODS

We used data from a randomized controlled trial of an interactive, cancer-communication video program using African American breast cancer survivor stories for newly diagnosed African American breast cancer patients (Stages 0-III). Participants completed five interviews over 2 years. This intervention did not significantly affect changes in quality-of-life outcomes. In secondary analysis, we examined differences in baseline variables between women with and without diabetes. Logistic regression models identified independent predictors of receiving advice from "a doctor or other health professional" to improve diet and exercise and of self-reported change in diet and exercise habits at 2 year follow-up.

RESULTS

Of 193 patients included (85% of 228 enrolled), 53 (28%) had diabetes. At 2 year follow-up, a greater proportion of women with (vs. without) diabetes reported receiving advice by a doctor/health professional to improve their diet (73% vs. 57%, p = .04,). Predictors of receiving dietary advice were obesity, diabetes, and breast-conserving surgery (each p < .05). Women receiving dietary advice were 2.75 times more likely to report improving their diet (95% confidence interval: 1.17, 6.46) at follow-up, but receiving physical activity advice was not significantly associated with patients reporting an increase in exercise.

CONCLUSIONS

Although receiving dietary advice predicted dietary improvements, receiving exercise advice did not lead to an increase in physical activity.

CLINICAL TRIAL REGISTRATION

Trial Number NCT00929084.

Association of depression symptoms with receipt of healthcare provider advice on physical activity among US adults

BACKGROUND

Given the high burden and prevalence of depression, various guidelines underscore the role of healthcare providers in supplying advice on physical activity (PA) as a potential modifying factor influencing the incidence and severity of depressive symptoms in adults. We aimed to investigate the extent to which healthcare providers provide PA advice to adults with depressive symptoms in the US.

METHODS

Data on adults aged 20-64 years (n = 4971) in the National Health and Nutrition Examination Study between 2011 and 2016 were analysed. Depressive symptoms were assessed using the Patient Health Questionnaire and response options were categorised as "none or minimal", "mild", "moderate-severe". Receipt of PA advice from a healthcare provider was self-reported. We restricted our study sample to adults free from chronic diseases.

RESULTS

Higher odds of receiving advice to exercise were reported among adults with mild (OR = 1.7, 95% CI: 1.3-2.3) and moderate-severe depressive symptoms (OR = 1.7, 95% CI: 1.0-2.8). Furthermore, exercise advice was more commonly reported among adults who were overweight, obese, Hispanic, Asian, being insured with private insurance, with education higher than high school, and had access to a routine place for health care.

LIMITATIONS

Social and culutral aspects of overweight/obesity may prohibit generalizations. Cross sectional design does not allow for causal realtionships.

CONCLUSIONS

In the US, fewer than one in three adults experiencing symptoms of depression report having received exercise advice from a healthcare provider. Providing such advice may be a sustainable clinical strategy in reducing the incidence and severity of depression symptoms.

Professional appraisal of online information about children's footwear measurement and fit: readability, usability and quality

Background

Parents increasingly use the internet to seek health information, share information and for purchasing textiles and footwear. This shift in footwear purchasing habits raises concern about how (and if) parents are getting their children's feet measured, and what support strategies are in place to support the fit of footwear. In response to this, some companies and healthcare organisations have developed resources to support home measurement of foot size, and link these measures to footwear selection, measurement and fitting. The aim of this research was to undertake an appraisal of web-based resources about measurement and fit of children's footwear, focussing specifically on readability, usability and quality.

Methods

Search terms relating to children's foot measurement were compiled and online searching was undertaken. Search results were saved and screened for relevance. Existing resources were categorised based on their source e.g. a footwear company or a health website. The 15 most commonly identified resources were reviewed by a professional panel for readability, content, usability and validity. One researcher also assessed the accessibility and reading ease of the resources.

Results

Online resources were predominantly from commercial footwear companies (54%). Health information sources from professional bodies made up 4.2% of the resources identified. The top 15 resources had appropriate reading ease scores for parents (SMOG Index 4.3-8.2). Accessibility scores (the product of the number of times it appeared in search results and its ranking in the results) were highest for commercial footwear companies. The panel scores for readability ranged from 2.7 to 9 out of 10, with a similar range for content, usability and validity.

Conclusions

Information for parents seeking to purchase footwear for their children is readily available online but this was largely dominated by commercial footwear companies. The quality and usability of this information is of a moderate standard; notable improvements could be made to the validity of the task the child is asked to undertake and the measures being taken. Improvements in these resources would improve the data input to the selection of footwear and therefore have a beneficial impact on footwear fit in children.

Spanish version of the Satisfaction with Epilepsy Care questionnaire: Adaptation and psychometric properties

OBJECTIVE

The objective of this study was to perform a cross-cultural adaption and psychometric evaluation of the Spanish version of the Satisfaction with Epilepsy Care (SEC) questionnaire and analyze patient satisfaction with epilepsy care.

METHODS

Transcultural adaptation and validation of the SEC were carried out using translation and back-translation with pilot testing and an expert panel. The SEC-E (Spanish) was analyzed in 213 patients with epilepsy to examine construct and criterion validity and internal consistency.

RESULTS

The SEC-E achieved conceptual, semantic, and content equivalence with the original version. For content validity, one question was eliminated from the original questionnaire as it has little relevance in our cultural setting. Positive correlations for criterion validity were obtained using the gold standard measure (Satisfaction in Hospitalized Patients scale). Construct validity replicated the three dimensions of the original questionnaire. The scale showed adequate reliability through internal consistency (Cronbach's α of 0.94) and temporal stability on retest (n = 85). Patients scored (0 to 100) 77.5 [standard deviation (SD): 19.9] for satisfaction with communication, 76.9 (SD: 17) for organization, and 67.2 (SD: 22.1) for information.

SIGNIFICANCE

The SEC-E is a valid and reliable tool for the assessment of educational interventions aiming to improve the quality of care in patients with epilepsy in Spanish clinical practice. The results showed a good level of patient satisfaction with epilepsy care.

Provider advice on physical activity and nutrition in twin pregnancies: a cross-sectional electronic survey

Background

Health care providers should counsel pregnant patients on physical activity and nutrition to improve pregnancy outcomes. However, little is known about provider advice on these lifestyle behaviors among women pregnant with twins, a growing population at high risk for pregnancy complications. We examined the prevalence and content of provider advice on physical activity and nutrition among women pregnant with twins.

Methods

A cross-sectional electronic survey was administered to 276 women who delivered twins in the past 3 years and received prenatal care in the United States. The proportion of women reporting provider advice on physical activity and nutrition during prenatal visits (yes/no) was assessed and open-ended questions examined the content of provider advice. Bivariate differences in participant characteristics, stratified by provider advice on physical activity and nutrition (yes/no), were assessed. Responses from open-ended questions were examined using a content analysis approach to identify commonly reported advice on physical activity and nutrition.

Results

Approximately 75 and 63% of women reported provider advice on physical activity and nutrition, respectively, during their twin pregnancy. Women who recalled advice on physical activity most commonly reported recommendations to walk at a light to moderate intensity level. However, few women reported physical activity recommendations consistent with current guidelines, and approximately 55% of women reported provider advice to limit or restrict activity during their pregnancy, including bedrest. Nutrition advice was focused on eating a healthy, balanced diet and increasing protein intake. More women reported self-initiating the conversation on physical activity with their provider (40%) compared to nutrition (21%). Despite limited advice, 70% of women reported being satisfied or very satisfied with the information they received from their provider on physical activity or nutrition.

Conclusions

The majority of women reported provider advice on physical activity and nutrition during their twin pregnancies. However, advice was limited in detail, and physical activity levels were commonly restricted, despite the lack of evidence that activity restriction is beneficial during pregnancy. More research is needed to determine the optimal physical activity and dietary patterns in twin pregnancies to facilitate clear and consistent provider counseling on these lifestyle behaviors.

What exercise advice are women receiving from their healthcare practitioners during pregnancy?

BACKGROUND

Exercise during pregnancy is associated with a variety of health benefits for both mother and child. Despite these benefits, few Australian pregnant women are sufficiently active to meet current exercise during pregnancy guidelines. Healthcare practitioners can play an instrumental role in encouraging women to be active during their pregnancy through the provision of clear and accurate exercise advice. However, little is known about the exercise advice that pregnant women receive from Healthcare practitioners.

METHODS

Regionally-based Australian women were asked to self-report the exercise advice they received from their Healthcare practitioners during their pregnancy via a survey during one of their clinic visits.

RESULTS

Of the 131 participants, 53% (n=70) reported receiving some form of exercise advice from their Healthcare practitioner. Specifically, frequency of exercise was discussed among 34% of the participants (n=23) while exercise intensity 57% was discussed among 57% of the participants (n=38). Exercise duration was discussed among 39% of participants (n=26) and types of exercise was discussed among 84% of the participants (n=56). In most instances, participants report receiving advice not in accordance with current exercise during pregnancy guidelines.

CONCLUSIONS

Healthcare practitioners may not be actively providing advice to pregnant women about their exercise behaviours. Of the advice that is provided, it may not in accordance with current evidence-based exercise during pregnancy guidelines. Whilst healthcare practitioners may be uniquely positioned to provide exercise advice to pregnant women, they may not have the necessary knowledge, training or support to provide specific exercise advice.

Support for people who use Anabolic Androgenic Steroids: A Systematic Scoping Review into what they want and what they access

BACKGROUND

Since there is a paucity of research on support for people using Anabolic Androgenic Steroids (AAS), we aimed to identify and synthesise the available evidence in this field. Gaining an understanding of the support both accessed and wanted by recreational AAS users will be of use to professionals who provide services to intravenous substance users and also to those working in the fields of public health and social care, with the aim to increase engagement of those using AAS.

METHODS

A systematic scoping review of the literature to explore and identify the nature and scope of information and support both accessed and wanted by non-prescribed AAS users. Any support services or information designed to help people who use AAS were considered.

RESULTS

We identified 23 papers and one report for review, which indicated that AAS users access a range of sources of information on: how to inject, substance effectiveness, dosages and side effects, suggesting this is the type of information users want. AAS users sought support from a range of sources including medical professionals, needle and syringe programmes, friends, dealers, and via the internet, suggesting that, different sources were used dependent on the information or support sought.

DISCUSSION

AAS users tended to prefer peer advice and support over that of professionals, and access information online via specialist forums, reflecting the stigma that is experienced by AAS users. These tendencies can act as barriers to accessing services provided by professionals.

CONCLUSIONS

Support needs to be specific and targeted towards AAS users. Sensitivity to their perceptions of their drug-use and the associated stigma of being classified in the same sub-set as other illicit drug users is relevant to facilitating successful engagement.

Twelve Tips for Applicants from a Disadvantaged Background Considering a Career in Medicine

This article was migrated. The article was marked as recommended. A minority of medical school entrants draw from disadvantaged backgrounds, which remain significantly under-represented within the medical workforce. Whilst multifactorial, this may in part relate to relative lack of information about the admissions process amongst these groups. In this article, Mohammed Abdul Waduud and colleagues offer their twelve essential tips to support students from disadvantaged backgrounds who are considering applying to medical school. The authors, all of whom are from disadvantaged backgrounds, have experience in applying to medical schools within the United Kingdom. The tips within this article should support students from disadvantaged backgrounds to decide whether a career in medicine is right for them and succeed in their applications to study medicine.

The association between the receipt of primary care clinician provision of preventive care and short term health behaviour change

Primary healthcare services are recommended to provide preventive care to address chronic disease risk behaviours. However, all care elements are infrequently provided, and there is a need to understand the impact of partial care provision on behaviour change. This study examined the association between variable levels of preventive care receipt from primary care clinicians on short-term behaviour change for four risk behaviours. A survey was undertaken with 5639 Australian community health service clients (2009-2014). Clients self-reported: engagement in risk behaviours (tobacco smoking, harmful alcohol consumption, inadequate fruit and/or vegetable consumption, physical inactivity) in the month prior to and four week post their community health service appointment; receipt of preventive care during appointments (assessment, advice, referral/follow-up) for each behaviour. Univariate regression models explored the association between change in risk status and preventive care received. The odds of behaviour change for those receiving all three care elements was significant for all behaviours, compared to no care, ranging from 2.02 (alcohol consumption, 95% CI 1.16-3.49) to 4.17 (inadequate fruit and/or vegetable consumption, 95% CI 2.91-5.96). Receipt of both assessment and advice increased the odds of behaviour change, compared to no care, for all behaviours except smoking, ranging from 2.32 (physical inactivity, 95% CI 1.60-3.35) to 2.83 (alcohol consumption, 95% CI 1.84-4.33). Receipt of 'assessment only' increased the odds of behaviour change, compared to no care, for inadequate fruit and/or vegetable consumption (OR = 2.40, 95% CI 1.60-3.59) and physical inactivity (OR = 2.81, 95% CI 1.89-4.17). Results highlight the importance of primary care clinicians providing best practice preventive care to maximise client behaviour change.

If I knew then what I know now: Advice to my younger self

If we could go back and give ourselves advice to keep from making a mistake, most of us would probably take that opportunity. Using self-discrepancy theory as a theoretical framework, US workers on Amazon's Mechanical Turk, who were at least 30 years of age, indicated in two studies what their advice to their younger selves would be, what pivotal event was influential for them, if they had regrets, and if following this advice would bring them closer to their ideal or ought self. Across both studies, most of the advice fell into the domains of relationships, education, and selfhood. Participants said following the advice would bring them more in line with their ideal than their ought self. Following the advice also led to more positive perceptions of the current self by the high school self. Ages at which pivotal events occurred provided strong support for the reminiscence bump.

Empathically designed responses as a gateway to advice in Dutch counseling calls

Previous conversation analytic studies of institutional interaction included analyses of empathy in interaction. These studies revealed that professionals may use empathy displays not only to validate the client's worry, but also to perform actions oriented to other institutional goals and tasks such as closing off a troubles-telling sequence. In this article, we present an analysis of empathically designed responses in Dutch telephone counseling. The data consist of 36 calls from the Alcohol and Drugs Info Line. In some of the calls, clients' troubles-telling includes 'emotion discourse', that is, descriptions of their feelings/emotions. Counselors may respond to these descriptions using conventional empathy displays like 'I can imagine that' and 'I understand that' in a range of verbal and prosodic variations. The analysis reveals that these responses open up advice sequences that vary in the extent to which they treat the client's articulated feelings as valid. Most are affiliating, treating the client's feelings as the basis for advice, while some are less affiliative, putting the client's feelings into perspective or implicitly questioning their legitimacy. Hence, empathically designed responses are pivots to advice-giving.

Comparing satisfaction with a participatory driven web-application and a standard website for patients with low back pain: a study protocol for a randomised controlled trial (part of the ADVIN Back Trial)

Background

Low back pain (LBP) is the most common musculoskeletal disorder and a leading cause of disability worldwide. It impacts daily life and work capacity and is the most common reason for consulting a general practitioner (GP). According to international guidelines, information, reassurance, and advice are key components in the management of people with LBP; however, the consultation time available in general practice for each patient is often limited. Therefore, new methods to support the delivery of information and advice are needed and online technologies provide new opportunities to extend the consultation beyond the GP’s office. However, it is not known whether GPs and people consulting their GP because of LBP will accept online technologies as part of the consultation. By involving patients in the development of online information, we may produce more user-friendly content and design, and improve patient acceptance and usage, optimising satisfaction and clinical outcomes. The purpose is to study satisfaction in people consulting their GP with LBP depending on whether they are randomised to receive supporting information through a new participant-driven web application or a standard reference website containing guideline-based information on LBP. It is hypothesised that patients offered information in a new web application will be more satisfied with the online information after 12 weeks compared to patients allocated to a standard website.

Methods

Two hundred patients with LBP aged ≥ 18 years consulting Danish general practice will be randomly allocated 1:1 to either the new web application or standard online information in permuted blocks of two, four, and six. Patients with serious spinal diseases (cancer, fractures, spinal stenosis, spondyloarthritis), those without Danish reading skills or without online access, and pregnant women will not be included in the trial. Patient satisfaction measured by the Net Promotor Score after 12 weeks is the primary outcome. Patients will be aware of their allocation. GPs will be blinded unless informed by the patient. Assessors are blinded.

Discussion

To our knowledge, this is the first trial evaluating whether involving LBP patients in the development of an online web application will result in higher patient satisfaction.

Trial registration

ClinicalTrials.gov NCT03088774. Registered on 23 March 2017. Last updated on 14 March 2018.

Electronic supplementary material

The online version of this article (10.1186/s13063-018-2795-0) contains supplementary material, which is available to authorized users.

Compliance with Iron and folic acid supplementation (IFAS) and associated factors among pregnant women: results from a cross-sectional study in Kiambu County, Kenya

BACKGROUND

Macro and micronutrients including iron and folic acid deficiencies are prevalent in Kenya, particularly during pregnancy resulting in anaemia. Despite efforts to control anaemia in pregnancy by adopting Iron and Folic Acid Supplementation (IFAS), this public health problem has persisted contributing to significant morbidity and mortality. The problem notwithstanding, there is poor IFAS compliance, whose reasons remain poorly understood, calling for their investigations. We sought to determine compliance status with IFAS and associated factors among pregnant women.

METHODS

This was a cross-sectional study involving 364 pregnant women aged 15-49 years. Using two stage cluster sampling, one Sub-County and five public health facilities in Kiambu County were selected. All pregnant women attending antenatal clinics who met inclusion criteria and consented to participate in the study were recruited. Compliance with IFAS was defined as taking supplements at least 5 out of 7 days per week. A structured interviewer-administered questionnaire consisting of sociodemographic data, IFAS maternal knowledge and compliance practices was pretested and administered. Descriptive and inferential statistics were computed using STATA.

RESULTS

Of the 364 respondents interviewed, 32.7% were IFAS compliant and 40.9% scored high on its knowledge. Of those with high IFAS knowledge, 48.3% were compliant compared to those with low knowledge (21.4%, n = 46, PR = 2.25;95%CI = 1.59-3.17, p < 0.001). Women who were multigravid (30.4%) were less likely to comply compared to primigravid (37.2%, n = 45, PR = 0.68;95%CI = 0.47-0.99, p = 0.004). Multivariate analysis revealed that respondents counselled on management of IFAS side effects (100%, n = 4) were more compliant (76.2%, n = 112, aPR = 1.31;95%CI = 1.19-1.44, p < 0.001).

CONCLUSION

Few pregnant women were compliant with IFAS regimen, associated with: knowledgeability on IFAS, primi-gravidity, and IFAS counselling especially on management of its side effects. These underscore the need for approaches to scale up health awareness on the benefits of IFAS, mitigation measures for the side effects, as well as targeted counselling.

Parents' advice to healthcare professionals working with children who have spinal muscular atrophy

AIM

To explore parents' advice to healthcare professionals working with children with spinal muscular atrophy (SMA).

MATERIALS AND METHODS

This study derives from a Swedish nationwide survey and uses content analysis to make inferences from answers to an open-ended question concerning parent's advice to healthcare professionals. Of eligible parents who had a child born in Sweden between 2000 and 2010, diagnosed with SMA type 1 or 2, and for whom respiratory support was considered in the first year of life, 61 participated in the study (response rate: 87%). Of these, 51 parents answered the question about advice to healthcare professionals working with children with SMA.

RESULTS

More than half of the advice from parents was related to professional-family relations. The second most frequent type of advice related to two aspects of knowledge about SMA: desire that healthcare professionals possess knowledge, and desire that they provide knowledge. The parents also had advice concerning support in daily life, both to the parents and to the affected child. Other pieces of advice were related to organization of care and the parents' desire to be involved in the child's care.

CONCLUSIONS

Parents advised healthcare professionals to increase their disease-specific knowledge, to treat the parents as experts on their child, and to treat the family with respect, particularly in situations where the child's case is used as an opportunity to improve healthcare professionals' competence. Increased practical support in daily life and a case coordinator is also among parents' advice to healthcare professionals.

Lessons learned from women in leadership positions

BACKGROUND

Eileen Elias has decades of experience in leadership positions within government and nongovernmental organizations. As the first female Commissioner for Mental Health in the Commonwealth of Massachusetts and the US in the early 1990s, Elias gained experience on navigating gender-based challenges to attain recognized performance outcomes.

OBJECTIVE

From lessons learned from women leaders, educate young women entering their careers on attaining leadership positions.

METHODS

Comprehensive research of literature from 2012 through 2017 and interviews with women leaders representing non-Fortune 500 companies including academia, research, non-profit, for-profit, and primary and secondary education. Interviewees included:1.Gail Bassin, Co-Chief Executive Officer and Treasurer, JBS International Inc.2.Jeri Epstein, Executive Director, The Ambit Foundation3.Valerie Fletcher, Executive Director, Institute for Human Centered Design4.Christine James-Brown, President and CEO, Child Welfare League of America5.Daria Mochly-Rosen, PhD, Professor and Fellow, Chemical and Systems Biology, Stanford University School of Medicine6.Eileen O'Keefe, MD, MPH, Clinical Associate Professor and Director, Boston University Health Sciences7.Jeri Shaw, President and Co-Chief Executive Officer, JBS International Inc.

RESULTS/CONCLUSIONS

A comprehensive understanding of key women leaders' lessons learned and recommendations targeting young women as they assess leadership opportunities in the public or private sectors.

Smoking Cessation Advice: Knowledge, Attitude, and Practice among Clinical Dental Students'

BACKGROUND

Smoking is the single most important public health challenge facing the National Health Service. The detrimental effects on the general health of tobacco smoking are well documented. Smoking is a primary risk factor for oral cancer and many oral diseases. Dental professional scan plays an important role in preventing adverse health effects by promoting smoking cessation.

OBJECTIVE

To assess the knowledge, attitude, and practice among clinical dental students in giving smoking cessation advice and to explore the barriers to this activity.

MATERIALS AND METHODS

A total of 262 clinical dental trainee of two dental colleges (College of Dental Sciences and Bapuji Dental College) of Davangere city were included in the survey. A self-administered questionnaire was administered to assess the knowledge, attitude, and practice toward Tobacco Cessation Advise.

RESULTS

Among the 262 participants in the study, around 51% said they know about Nicotine Replacement Therapy, and among them, only 4.6% were aware of the options available in the market. When asked about 5A's of tobacco cessation, only 35.5% were aware of it. Similarly, when asked about 5R's of tobacco cessation, 48.5% were unaware of it.

CONCLUSIONS

The respondents did not have sufficient knowledge regarding tobacco cessation advice. With patient's disinterest and lack of time being quoted as the important barriers in providing tobacco cessation advice, it is highly recommended that there is need to incorporate few chapters on tobacco, its effect and cessation of habit in the undergraduate dental curriculum with simultaneous application of the same in clinical practice.

Trust in Sources of Advice about Infant Care Practices: The SAFE Study

Objectives (1) Determine the prevalence of maternal trust in advice sources on infant care practices; (2) Investigate the association of maternal and infant characteristics with trust in advice sources on infant care practices. Methods Using probability sampling methods, we recruited mothers from 32 U.S. maternity hospitals with oversampling of Black and Hispanic women resulting in a nationally representative sample of mothers of infants aged 2-6 months. Survey questions assessed maternal trust in advice sources (physicians, nurses, family, friends, and media) regarding infant care practices including infant sleep practices (sleep position, bed sharing, and pacifier use), feeding, and vaccination. Weighted frequencies of maternal trust in advice sources were calculated to obtain prevalence estimates. Multivariable logistic regression was used to assess the association of maternal and infant characteristics with maternal trust in advice sources. Results Mothers had the greatest trust in doctors for advice on all infant care practices (56-89 %), while trust was lowest for friends (13-22 %) and the media (10-14 %). In the adjusted analyses, there were significant associations of maternal race/ethnicity, education, and age with trust in advice sources. Conclusions for Practice Maternal trust in advice about infant care practices varied significantly by source. A better understanding of which advice sources are most trusted by mothers, as well as the factors associated with maternal trust, may guide the development of more effective strategies to improve adherence to health promoting infant care practices.

Advice for acute low back pain: a comparison of what research supports and what guidelines recommend

BACKGROUND

Advice is widely considered an effective treatment for acute low back pain (LBP); however, details on what and how to deliver this intervention is less clear.

PURPOSE

We assessed and compared clinical trials that test advice for acute LBP with practice guidelines for their completeness of reporting and concordance on the content, method of delivery, and treatment regimen of advice interventions.

DESIGN/SETTING

Systematic review.

METHODS

Advice randomized controlled trials were identified through a systematic search. Guidelines were taken from recent overviews of guidelines for LBP. Completeness of reporting was assessed using the Template for Intervention Description and Replication checklist. Thematic analysis was used to characterize advice interventions into topics across the aspects of content, method of delivery, and regimen. Concordance between clinical trials and guidelines was assessed by comparing the number of trials that found a statistically significant treatment effect for an intervention that included a specific advice topic with the number of guidelines recommending that topic.

RESULTS

The median (interquartile range) completeness of reporting for clinical trials and guidelines was 8 (7-9) and 3 (2-4) out of nine items on the Template for Intervention Description and Replication checklist, respectively. Guideline recommendations were discordant with clinical trials for 50% of the advice topics identified.

CONCLUSION

Completeness of reporting was less than ideal for randomized controlled trials and extremely poor for guidelines. The recommendations made in guidelines of advice for acute LBP were often not concordant with the results of clinical trials. Taken together, these findings mean that the potential clinical value of advice interventions for patients with acute LBP is probably not being realized.

Increasing the provision of preventive care by community healthcare services: a stepped wedge implementation trial

Background

Although clinical guidelines recommend the provision of care to reduce client chronic disease risk behaviours, such care is provided sub-optimally by primary healthcare providers. A study was undertaken to determine the effectiveness of an intervention in increasing community-based clinician implementation of multiple elements of recommended preventive care for four risk behaviours.

Methods

A three-group stepped-wedge trial was undertaken with all 56 community-based primary healthcare facilities in one health district in New South Wales, Australia. A 12-month implementation intervention was delivered sequentially in each of three geographically and administratively defined groups of facilities. The intervention consisted of six key strategies: leadership and consensus processes, enabling systems, educational meetings and training, audit and feedback, practice change support, and practice change information and resources. Client-reported receipt of three elements of preventive care: assessment; brief advice; referral for four behavioural risks: smoking, inadequate fruit and/or vegetable consumption, alcohol overconsumption, and physical inactivity, individually, and for all such risks combined were collected for 56 months (October 2009–May 2014). Segmented logistic regression models were developed to assess intervention effectiveness.

Results

A total of 5369 clients participated in data collection. Significant increases were found for receipt of four of five assessment outcomes (smoking OR 1.53; fruit and/or vegetable intake OR 2.18; alcohol consumption OR 1.69; all risks combined OR 1.78) and two of five brief advice outcomes (fruit and/or vegetable intake OR 2.05 and alcohol consumption OR 2.64). No significant increases in care delivery were observed for referral for any risk behaviour, or for physical inactivity.

Conclusions

The implementation intervention was effective in enhancing assessment of client risk status but less so for elements of care that could reduce client risk: provision of brief advice and referral. The intervention was ineffective in increasing care addressing physical inactivity. Further research is required to identify barriers to the provision of preventive care and the effectiveness of practice change interventions in increasing its provision.

Trial registration

Australian Clinical Trials Registry ACTRN12611001284954. Registered 15 December 2011. Retrospectively registered.

Lifestyle advice provision to teenage and young adult cancer patients: the perspective of health professionals in the UK

PURPOSE

Health professionals are an important source of information for teenage and young adult (TYA) cancer patients. However, little is known about health professionals' provision of lifestyle advice to young people with cancer who are in their care.

METHODS

An online survey was distributed to health professionals within the UK who identified themselves as working with TYA cancer patients. Health professional awareness of lifestyle guidance, provision of lifestyle advice to young people and views on lifestyle information format and delivery were explored.

RESULTS

Ninety-five health professionals (44% nurses; 28% allied health professionals; 17% physicians) completed the survey. The majority (72%) of respondents were aware of some lifestyle guidance for cancer patients. However, less than half of TYA health professionals (46%) were able to successfully recall the source of the guidelines and less than a third reported proving specific advice to the majority of their patients on weight management, smoking, alcohol consumption and sun safety. Many health professionals (38%) felt that they were not the right person to provide advice and cited lack of resources as a key barrier to advice provision. The majority (95%) reported being interested in a resource containing relevant lifestyle information that could be given to young people with cancer.

CONCLUSIONS

TYA health professionals' awareness of lifestyle guidance and provision of advice regarding health behaviour is sub-optimal. Clear and comprehensive guidance written specifically for TYA health professionals could overcome the reported barriers and improve professionals' confidence in addressing and providing advice on lifestyle to young people with cancer.

Obstacles to engaging in young driver licensing: Perspectives of parents

INTRODUCTION

Young novice drivers remain at greater risk of injury and death despite a wealth of interventions including graduated driver licensing (GDL) programs. The key to implementing safer practices inherent in GDL appears to lie with optimising the role of parents. This qualitative research explored the parent's perspectives of obstacles to engaging in the driver licensing process within a GDL program. Parents also shared advice on what they found helpful, and where relevant, recommended changes in the process to enable safer practices for young drivers.

METHOD

Twenty-three parents (aged 35-60 years, M=49.52, SD=8.01, 11 males) participated in semi-structured interviews regarding licensing experiences with their young driver children. The young drivers included learner (n=11), provisional (restricted/intermediate) (n=9) and open (unrestricted/full) licence drivers (n=3), ranging from 16 to 24 years (M=18.04, SD=2.21, 13 males).

FINDINGS AND CONCLUSIONS

Content analysis revealed that most obstacles were encountered at the learner licensing phase, with the parent-reported difficult temperament of the learner driver the most prominent. Unsurprisingly, advice to other parents to be patient and remain calm featured heavily during the same phase. Anxiety from not having control of the vehicle was another obstacle at the learner phase, translating to anxieties for child safety in the early stages of provisional driving. Recommendations for the current GDL included more rigorous road rule testing, with general support for the program, professional driver training at learner and provisional stages facilitated parental engagement through the licensing phases.

PRACTICAL APPLICATIONS

The findings overwhelmingly suggest a need for parents to be educated regarding their importance in, and of, the driver licensing process, and the efficacy of their instruction, content and practices.

Advice given by community members to pregnant women: a mixed methods study

Background

Smoking and excess weight gain during pregnancy have been shown to have serious health consequences for both mothers and their infants. Advice from friends and family on these topics influences pregnant women’s behaviors. The purpose of our study was to compare the advice that community members give pregnant women about smoking versus the advice they give about pregnancy weight gain.

Methods

A survey was sent via text messaging to adults in a diverse, low-income primary care clinic in 2015. Respondents were asked what advice (if any) they have given pregnant women about smoking or gestational weight gain and their comfort-level discussing the topics. Descriptive statistics were used to characterize the sample population and to determine response rates. Open-ended responses were analyzed qualitatively using grounded theory analysis with an overall convergent parallel mixed methods design.

Results

Respondents (n = 370) were 77 % female, 40 % black, and 25 % reported education of high school or less. More respondents had spoken to pregnant women about smoking (40 %, n = 147) than weight gain (20 %, n = 73). Among individuals who had not discussed either topic (n = 181), more reported discomfort in talking about weight gain (65 %) compared to smoking (34 %; p < 0.0001). Advice about smoking during pregnancy (n = 148) was frequently negative, recommending abstinence and identifying smoking as harmful for baby and/or mother. Advice about weight gain in pregnancy (n = 74) revealed a breadth of messages, from reassurance about all weight gain (“Eat away” or “It’s ok if you are gaining weight”), to specific warnings against excess weight gain (“Too much was dangerous for her and the baby.”).

Conclusions

Many community members give advice to pregnant women. Their advice reveals varied perspectives on the effects of pregnancy weight gain. Compared to a nearly ubiquitous understanding of the harms of smoking during pregnancy, community members demonstrated less awareness of and willingness to discuss the harms of excessive weight gain. Beyond educating pregnant women, community-level interventions may also be important to ensure that the information pregnant women receive supports healthy behaviors and promotes the long-term health of both moms and babies.