Food-related quality of life is impaired in inflammatory bowel disease and associated with reduced intake of key nutrients.

BACKGROUND: Inflammatory bowel disease (IBD) may impact the extent to which food, eating, and drinking bring satisfaction and enjoyment to peoples' lives, and this may impact dietary intake. The prevalence of an impaired food-related quality of life (FR-QoL), its associated factors, and its impact on diet have not been explored. OBJECTIVES: To measure the prevalence and nature of the burden of impaired FR-QoL in people with IBD, the factors associated with these, and their associations with nutrient intake. METHODS: We recruited 1576 outpatients with IBD (≥16 years old) in person from 7 IBD centers across the United Kingdom. Patients completed validated questionnaires to measure their FR-QoL, quality of life (QoL), distress, fatigue, anxiety, and depression. Dietary intake was recorded using the European Prospective Investigation into Cancer FFQ. A health professional recorded disease activity, Montreal classification, blood results, BMI, and malnutrition risk. FR-QoL was regressed onto explanatory variables using univariable and multivariable analyses. RESULTS: Data from 1221 patients were available (77.4% response; Crohn's disease, 65%; ulcerative colitis, 35%). The FR-QoL mean (± SD) score was 80.8 ± 26.9, with wide ranges (minimum, 29; maximum, 145). Following multivariable regression, the strongest associations with FR-QoL were the number of recent disease flares (5 flares ß = -12.7; P < 0.001), the IBD-specific QoL (ß = 0.33; P < 0.001), and IBD-related distress (ß = -0.26; P < 0.001). Patients with poorer FR-QoL had lower intakes of fiber (nonstarch polysaccharide; Q1 to Q5 difference = 2.1 g/d; 95% CI: 0.4-3.8; P = 0.048), calcium (192.6 mg/d; 95% CI: 112.5-272.6; P < 0.001), phosphorus (167 mg/d; 95% CI: 58-276; P = 0.041), and magnesium (34.4 mg/d; 95% CI: 9.3-59.4; P = 0.041). CONCLUSIONS: Impaired FR-QoL is prevalent in IBD and is associated with recurrent disease flares, a reduced IBD-specific QoL, and greater IBD-related distress. A poorer FR-QoL was associated with lower intakes of key nutrients of importance to IBD, including those relating to gut health and bone mineralization.

Piloting an interprofessional chronic pain management program: Perspectives of health students and community clients.

Interprofessional learning (IPL) is vital for developing work-ready graduates of tertiary health professions and enhancing outcomes of patients with chronic pain. Twenty-two students from six health professions participated in or co-facilitated components of a 6-week group chronic pain management program. Twelve community clients with chronic pain and one family member participated. The program was piloted through the University of Tasmania Exercise Physiology Clinic and consisted of an initial assessment, weekly 1-hour group education sessions, and a 1-hour individualized, supervised exercise session. The program was evaluated using a constructivist approach via an investigator developed survey. Seven students and nine clients responded. A conventional content analysis was undertaken. Three categories were identified from students: Importance of IPL, Understanding Chronic Pain, and Improvement Suggestions. Three categories were identified from clients including Beneficial Aspects, Positive Peer Support, and Positive Pain Outcomes. Results indicate the program was beneficial for student learning and improved pain outcomes for participants. The model demonstrates value to student IPL and the potential to flexibly offer a real-world learning experience across many health professions, whilst addressing some of the common challenges associated with implementing IPL within curricula. The outcomes offer ways to explore sustainable implementation of the program long term.

The role of climate change education on individual lifetime carbon emissions.

Strategies to mitigate climate change often center on clean technologies, such as electric vehicles and solar panels, while the mitigation potential of a quality educational experience is rarely discussed. In this paper, we investigate the long-term impact that an intensive one-year university course had on individual carbon emissions by surveying students at least five years after having taken the course. A majority of course graduates reported pro-environmental decisions (i.e., type of car to buy, food choices) that they attributed at least in part to experiences gained in the course. Furthermore, our carbon footprint analysis suggests that for the average course graduate, these decisions reduced their individual carbon emissions by 2.86 tons of CO2 per year. Surveys and focus group interviews identify that course graduates have developed a strong personal connection to climate change solutions, and this is realized in their daily behaviors and through their professional careers. The paper discusses in more detail the specific components of the course that are believed to be most impactful, and the uncertainties associated with this type of research design. Our analysis also demonstrates that if similar education programs were applied at scale, the potential reductions in carbon emissions would be of similar magnitude to other large-scale mitigation strategies, such as rooftop solar or electric vehicles.

Expanding capacity for supervision in general practice through student-engaged clinical audit.

BACKGROUND: Expanding clinical teaching opportunities is essential for securing a sustainable health workforce. Although Tasmanian general practitioners (GPs) are keen to provide learning opportunities for medical students, they have identified time pressures due to a need to meet patient service demand and a need for more guidance on effective clinical teaching, as factors impacting their ability to increase clinical supervision. By developing a clinical audit activity, we delivered an educational resource that did not require direct GP supervision yet provided meaningful learning outcomes for students. Through systematically reviewing patient records it was hoped that students would strengthen practice based quality improvement activities, thus 'giving back' to their placement practice. METHODS: A clinical audit curriculum was developed for fourth-year medical students at the Launceston Clinical School (n = 46) and implemented during their general practice rotation. This included a lecture and tutorial, and structured activities based on an audit of diabetes care. Preparation and support was provided to GP supervisors and practice staff through ongoing practice visits conducted by school academics. Implementation of the curriculum within general practice was evaluated through focus groups conducted with staff from five training practices (n = 29). Evaluation of student experiences is ongoing. RESULTS: This paper reports on the experiences of general practice supervisors and other practice staff. GPs and practice staff responded positively, indicating that the syllabus provided novel teaching opportunities and a modest contribution to improving patient records and patient care. Major learning opportunities identified included the development of skills working with patient records and practice software, and understanding the importance of accurate and reliable medical records for the optimal delivery of patient care. CONCLUSIONS: Conducting clinical audit provides students with novel learning opportunities while also strengthening the capacity of teaching general practices to provide clinical placements. Students learnt about the importance of monitoring professional practice using systematic clinical audit, and the complexities of managing patients within primary care. In so doing, they enhanced the robustness and rigor of patient records within their placement practice.

A randomized wait-list controlled analysis of the implementation integrity of team-initiated problem solving processes.

Members of Positive Behavior Interventions and Supports (PBIS) teams from 34 elementary schools participated in a Team-Initiated Problem Solving (TIPS) Workshop and follow-up technical assistance. Within the context of a randomized wait-list controlled trial, team members who were the first recipients of the TIPS intervention demonstrated greater implementation integrity in using the problem-solving processes during their team meetings than did members of PBIS Teams in the Wait-List Control group. The success of TIPS at improving implementation integrity of the problem-solving processes is encouraging and suggests the value of conducting additional research focused on determining whether there is a functional relation between use of these problem-solving processes and actual resolution of targeted student academic and social problems.

Evaluating the effects of ideology on public understanding of climate change science: how to improve communication across ideological divides?

While ideology can have a strong effect on citizen understanding of science, it is unclear how ideology interacts with other complicating factors, such as college education, which influence citizens' comprehension of information. We focus on public understanding of climate change science and test the hypotheses: [H1] as citizens' ideology shifts from liberal to conservative, concern for global warming decreases; [H2] citizens with college education and higher general science literacy tend to have higher concern for global warming; and [H3] college education does not increase global warming concern for conservative ideologues. We implemented a survey instrument in California's San Francisco Bay Area, and employed regression models to test the effects of ideology and other socio-demographic variables on citizen concern about global warming, terrorism, the economy, health care and poverty. We are able to confirm H1 and H3, but reject H2. Various strategies are discussed to improve the communication of climate change science across ideological divides.

A systematic review examining the literature on attitudes of patients with advanced cancer toward research.

The attitudes of heterogeneous groups of cancer patients towards research have been studied extensively. Less is known about these attitudes in the advanced cancer population. Such patients may have differing attitudes for a variety of reasons, including burden of disease and social factors. This systematic review examines the literature on attitudes of patients with advanced cancer toward research and aims to define common themes. The following databases were searched electronically: CINAHL (1982-2007), the Cochrane Database of Systematic Reviews (2007), Embase (1996-2007), and Medline (1996-2007). Additionally, the following journals were hand searched: Palliative Medicine, Journal of Pain and Symptom Management, and the European Journal of Palliative Care. The search terminologies used were: "Cancer" AND "Attitudes" AND "Research" AND "Palliative Care." All subheadings were included. Results were limited to English-language journals and studies involving humans. Of the 637 articles retrieved, 11 were included after an appraisal process. Both positive and negative attitudes toward research in advanced cancer were identified. Common themes of altruism, hope, and self-benefit were identified in 10 studies as a motivation for trial participation. Negative attitudes toward symptom control and risk of increased hospital admissions were identified in four studies. Most of the studies involved patients' views about participating in hypothetical trials, limiting the generalizability of results. An important step for future work would be to examine the experiences and opinions of patients with advanced cancer who have actually participated in a clinical trial.

Treatment of a Class I malocclusion with severe bimaxillary protrusion.

This report describes the treatment of a 20-year-old woman from Nigeria who had severe bimaxillary dentolveolar protrusion. The main issue in determining the appropriate treatment plan was the severity of the dentoalveolar protrusion. Four first premolars were extracted to reduce lip procumbancy. The change in the patient's facial esthetics was dramatic. Significant retraction of the upper and lower lips was achieved, and lip eversion and dentoalveolar protrusion were significantly improved. As the lips were retracted, mentalis strain was reduced; this improved chin projection. This case report was presented at an AAO meeting as part of the ABO student case display. It was chosen by committee to be published in the AJO-DO.

Problem behavior interventions for young children with autism: a research synthesis.

This paper provides a summary of research on behavioral interventions for children with autism 8 years of age or younger published between 1996 and 2000. The analysis is divided into four sections: (1) emerging themes in the technology of behavior support, (2) a review of existing research syntheses focusing on behavioral interventions, (3) a new literature review of current pertinent research, and (4) an evaluative discussion of the synthesis results and the field's future needs to develop effective behavioral interventions for young children with autism. The authors offer recommendations for strengthening the existing research base and advancing behavioral technology to meet the needs of the defined target population.