The provision of NHS health checks in a community setting: an ethnographic account.

BACKGROUND: The UK National Health Service Health Checks programme aims to reduce avoidable cardiovascular deaths, disability and health inequalities in England. However, due to the reported lower uptake of screening in specific black and minority ethnic communities who are recognised as being more at risk of cardiovascular disease, there are concerns that NHS Health Checks may increase inequalities in health. This study aimed to examine the feasibility and acceptability of community outreach NHS Health Checks targeted at the Afro-Caribbean community. METHODS: This paper reports findings from an ethnographic study including direct observation of four outreach events in four different community venues in inner-city Bristol, England and follow up semi-structured interviews with attendees (n = 16) and staff (n = 4). Interviews and field notes were transcribed, anonymized and analysed thematically using a process of constant comparison. RESULTS: Analysis revealed the value of community assets (community engagement workers, churches, and community centres) to publicise the event and engage community members. People were motivated to attend for preventative reasons, often prompted by familial experience of cardiovascular disease. Attendees valued outreach NHS Health Checks, reinforcing or prompting some to make healthy lifestyle changes. The NHS Health Check provided an opportunity for attendees to raise other health concerns with health staff and to discuss their test results with peers. For some participants, the communication of test results, risk and lifestyle information was confusing and unwelcome. The findings additionally highlight the need to ensure community venues are fit for purpose in terms of assuring confidentiality. CONCLUSIONS: Outreach events provide evidence of how local health partnerships (family practice staff and health trainers) and community assets, including informal networks, can enhance the delivery of outreach NHS Health Checks and in promoting the health of targeted communities. To deliver NHS Health Checks effectively, the location and timing of events needs to be carefully considered and staff need to be provided with the appropriate training to ensure patients are supported and enabled to make lifestyle changes.

Effectiveness of Anapana, Body scan and Metta meditation techniques on chronic neck and shoulder region pain and disability in adult patients in Sri Lanka: study protocol for a cluster clinic-level randomised controlled trial.

BACKGROUND: Chronic neck and shoulder region pain affects many people around the world. This study aims to compare the effectiveness of three 8-week meditation training programmes (each using a different meditation technique: Anapana, Body scan or Metta) on pain and disability in a patient population affected with chronic neck and shoulder region pain, with a usual care control group and with each other. METHODS: This four-arm parallel clinic-level randomised controlled trial will be conducted with male and female patients aged 18-65 years, who are affected with chronic neck and shoulder region pain, and who attend one of four clinics held on four different days of the week in a single medical centre in the Colombo North region, Sri Lanka. Clinics will be considered as clusters and randomly allocated to intervention and control arms. Data will be collected using validated questionnaires, clinical examinations and focus groups. To compare primary (differences in changes in pain (Numeric Pain Rating Scale) at 8 weeks) and secondary (differences in changes in pain, physical disability, range of movement and quality of life (SF-36) at 4 and 12 weeks) outcomes between groups, a two-way ANOVA will be used if data are normally distributed. If data are not normally distributed, a nonparametric equivalent (Kruskal-Wallis) will be used. Focus group transcriptions will be thematically analysed using the Richie and Spencer model of qualitative data analysis. DISCUSSION: This is a four-arm trial which describes how three different 8-week meditation technique (Anapana, Body Scan, Metta) interventions will be implemented with adult patients affected with chronic neck and shoulder region pain. The effectiveness of each meditation intervention on the pain, physical and psychosocial disabilities of patients will be compared between groups and with a usual care control group. The results of this study will contribute to recommendations for future meditation interventions for chronic neck and shoulder pain. TRIAL REGISTRATION: ISRCTN12146140 . Registered on 20 August 2021.

Contextual determinants of alcohol consumption changes and preventive alcohol policies: a 12-country European study in progress.

Beginning with France in the 1950s, alcohol consumption has decreased in Southern European countries with few or no preventive alcohol policy measures being implemented, while alcohol consumption has been increasing in Northern European countries where historically more restrictive alcohol control policies were in place, even though more recently they were loosened. At the same time, Central and Eastern Europe have shown an intermediate behavior. We propose that country-specific changes in alcohol consumption between 1960 and 2008 are explained by a combination of a number of factors: (1) preventive alcohol policies and (2) social, cultural, economic, and demographic determinants. This article describes the methodology of a research study designed to understand the complex interactions that have occurred throughout Europe over the past five decades. These include changes in alcohol consumption, drinking patterns and alcohol-related harm, and the actual determinants of such changes.

Use of morphometry to quantify osteolysis after total hip arthroplasty.

BACKGROUND: Progressive osteolysis threatens the longevity of hip arthroplasties and radiographic review is recommended. Measurement of osteolytic lesions in a clinical setting has not been achieved easily in the past. Other radiologic investigations provide accurate information but cost and risk to the patient prohibit their use in routine review. QUESTIONS/PURPOSES: We developed a simple, reliable tool to be used in hip arthroplasty review to quantify osteolytic changes seen on plain film radiographs. METHODS: A morphometric grid was developed and tested on simulated and actual osteolytic lesions. Four health professionals measured lesions on each of two occasions. Intraclass correlation coefficients (ICC) for interobserver and intraobserver reliabilities were calculated and Bland-Altman plots were constructed for graphic analysis. RESULTS: The ICCs for interobserver reliability on the simulated and actual osteolytic lesions were in the range 0.90 to 0.96. The values for intraobserver (test-retest) reliability were 0.97 to 0.98. The Bland-Altman plots confirmed agreement and in each case, proximity of the mean to zero indicated no significant bias. CONCLUSIONS: The data show a morphometric grid is reliable for measuring osteolytic changes after hip arthroplasty. CLINICAL RELEVANCE: This tool has potential to improve monitoring processes for hip arthroplasty and to be useful in future research studies. Additional work is needed to test for validity and clinical importance of the measurements obtained.

Motivators and de-motivators for adherence to a program of sustained walking.

OBJECTIVE: To investigate motivators, de-motivators and adherence to regular physical activity during and at six months after participation in a 12-week randomized controlled trial (RCT) of walking. DESIGN: Purposive sampling in a group of men who participated in a RCT of supported, home-based walking in Bristol, England, between December 2002 and June 2005. METHOD: 38 sedentary, hypercholesterolemic men (54.8 (5.0) years) who participated in a 12-week RCT of walking with regular professional support, were interviewed by telephone six months after the RCT. RESULTS: Health or fitness were the main motivational themes for adherence to walking during the RCT. Six-months after the RCT, 27 participants were still doing some walking and 18 were more physically active than before the RCT. In those who were still physically active, health benefits were motivators for adherence. In those who were less active, lack of time was a de-motivator with external support identified as a motivator for becoming more active. CONCLUSION: Health was the main motivating factor for adherence to physical activity during and after the supported RCT. Lack of external support was a de-motivator for sustaining physical activity.

Myofascial trigger point therapy for triceps surae dysfunction: a case series.

AIMS: The main aim of the case series was to inform further experimental research to determine the effectiveness of myofascial trigger point (MTrP) therapy for the treatment of triceps surae dysfunction. PARTICIPANTS: Ten participants with triceps surae dysfunction were recruited (4 females and 6 males); mean age±standard deviation=43±7.1 years. METHODS: Participants were screened for inclusion/exclusion criteria and the following outcomes measures were assessed at baseline and discharge; lower extremity functional scale (LEFS), verbal numerical rating scale (NRS), MTrP prevalence, ankle dorsiflexion range of movement (ROM) and pressure pain threshold (PPT). Intervention involved trigger point (TrP) pressure release, self MTrP release and a home stretching programme. RESULTS: There was a high prevalence of active/latent MTrPs and possible myofascial pain syndrome (MPS) for all 10 participants at baseline. Active MTrP prevalence decreased to 0%, while latent MTrPs were still present at discharge. There were positive changes in most outcome measures (LEFS, NRS, ROM and PPT) for all 10 participants. Short term to medium term treatment outcomes (6 week post discharge) showed an overall mean LEFS increase of 11 points from 61/80 at baseline to 72/80 at discharge. CONCLUSION: This case series suggests that a brief course of multimodal MTrP therapy would be helpful for some patients with sub-acute or chronic calf pain. Important preliminary data was gathered, that will inform more rigorous research in this under investigated area.

The prevalence of latent myofascial trigger points and diagnostic criteria of the triceps surae and upper trapezius: a cross sectional study.

OBJECTIVES: To determine the prevalence of latent myofascial trigger points (MTrPs), specific diagnostic criteria and the association between gender and MTrP prevalence in the triceps surae and upper trapezius. DESIGN: Cross-sectional study. SETTING: University, Faculty of Health and Life Sciences. PARTICIPANTS: Two hundred and twenty healthy volunteers (132 females and 88 males; mean age 29.7 (SD 11.0). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Prevalence of latent MTrPs in the triceps surae and comparative upper trapezius; specific diagnostic criteria and pressure pain threshold (PPT). RESULTS: Latent MTrPs were prevalent in all triceps surae (range: 13 to 30%), left upper trapezius (23%) and right upper trapezius (20%). No MTrPs (0%) identified in the middle fibres of deltoid. For each specific diagnostic criterion, taut bands were most prevalent in the right gastrocnemius medial head (81%); tender spot in left gastrocnemius medial head (52%) and nodules in the right upper trapezius (35%). Local twitch response (0.5%), the least frequent diagnostic criterion was only found in the left gastocnemius medial head. A significant increase in latent MTrP prevalence for females compared to males in five of the six triceps surae MTrP sites, with no significant association for gender and latent MTrP prevalence in the left or right upper trapezius. CONCLUSIONS: This study established the prevalence of latent MTrPs, specific diagnostic criteria and baseline normative data in the triceps surae. The middle fibres of deltoid were identified as a potential MTrP control site for future clinical research in the upper limb.

Empirical support for radiographic review: a follow-up study of total hip arthroplasty.

Routine post surgery surveillance of total hip arthroplasty (THA) is widely recommended to identify asymptomatic failure but inclusion of an x-ray adds to service costs. Evidence is needed to support orthopaedic opinion in order to identify what should be included in surveillance. An investigation was conducted to establish whether an x-ray is needed in addition to patient reported outcome measures. One hundred and fifty-four THA had been assessed at 3 years and were reviewed again at 6 to 9 years (mid-term) when radiographic signs of deterioration commonly appear. Data were explored for associations between radiographic changes and changes in the participants' Oxford Hip Score, age, EuroQol 5-D score or comorbidities. Hierarchical multiple regression analysis showed that the number of radiographic changes could not be predicted by any of the other variables. This supports the inclusion of an x-ray in THA surveillance and suggests that the state of the THA cannot be determined by the use of patient reported outcome measures alone. This has implications for future arthroplasty surveillance.

The effect of a home-based walking program on risk factors for coronary heart disease in hypercholesterolaemic men. A randomized controlled trial.

BACKGROUND: Hypercholesterolaemia and physical inactivity significantly contribute towards risk of coronary heart disease. Increased physical activity may be an effective way to improve lipid profiles in hypercholesterolaemic individuals. The aim of this study was to investigate whether a home-based physical activity program meeting current guidelines improved the lipid profile of hypercholesterolaemic men. METHODS: Sixty-seven hypercholesterolaemic men (55.1 (4.9) years), from Bristol England, recruited between 2002-2004, were randomized to either 12 weeks of brisk walking sufficient to expend at least 300 kcal each walk or control condition. Fasting lipids including total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), triglycerides (TG), glucose, insulin, blood pressure and anthropometric characteristics were measured at baseline and follow-up. Compliance was monitored using accelerometers and activity logs. RESULTS: After controlling for baseline differences, TC/HDL-C was significantly lower in the intervention group at follow-up (-0.28, 95% CI: -0.52, -0.03, p=0.03). An increase in HDL-C (0.07 mmol/l: -0.01, 0.12, p=0.07) and reduction in TG (-0.30 mmol/l: -0.64, 0.03, p=0.07) in intervention participants were of borderline statistical significance. Weight significantly decreased in intervention participants (-1.40 kg: -2.43, -0.38, p<0.01). No other significant between group effects were found. Compliance to the walking program was 97.6%. CONCLUSIONS: Twelve weeks of moderate intensity walking was sufficient to improve TC/HDL-C in hypercholesterolaemic men, primarily through improvement in HDL-C.