Public beliefs about the consequences of living with obesity in the Republic of Ireland and Northern Ireland.

BACKGROUND: This study aimed to capture public beliefs about living with obesity, examine how these beliefs have changed over time and to explore whether certain characteristics were associated with them in a nationally representative sample of adults from the Republic of Ireland (RoI) and Northern Ireland (NI). METHODS: A cross-sectional survey employed a random quota sampling approach to recruit a nationally representative sample of 1046 adults across NI and RoI. Telephone interviews captured information on demographics; health behaviours & attitudes; and beliefs about the consequences of obesity (measured using the Obesity Beliefs Scale). Univariable analyses compared beliefs about the consequences of living with obesity between participants with a self-reported healthy weight and those living with overweight or obesity, and non-responders (those for whom weight status could not be ascertained due to missing data). Multiple linear regression examined associations between obesity-related beliefs and socio-demographics, self-rated health and perceived ability to change health behaviours. Multiple linear regression also compared changes in obesity-related beliefs between 2013 and 2020 in the RoI. RESULTS: Higher endorsement of the negative outcomes of obesity was significantly associated with living with a healthy weight, higher self-rated health, dietary quality and perceived ability to improve diet and physical activity. Those who lived with overweight, with obesity and non-responders were less likely to endorse the negative consequences of obesity. Those living with obesity and non-responders were also more likely to support there is an increased cost and effort in maintaining a healthy weight. Comparison with survey data from 2013 showed that currently, there is a greater endorsement of the health benefits of maintaining a healthy weight (p < 0001), but also of the increased costs associated with it (p < 0001). CONCLUSION: Beliefs about the consequences of maintaining a healthy body weight are associated with individuals' weight, self-rated health, diet and perceived ease of adoption of dietary and exercise-related improvements. Beliefs about the health risks of obesity and perceived greater costs associated with maintaining a healthy weight appear to have strengthened over time. Present findings are pertinent to researchers and policy makers involved in the design and framing of interventions to address obesity.

Experience of discrimination and engagement with mental health and other services by Travellers in Ireland: findings from the All Ireland Traveller Health Study (AITHS).

OBJECTIVES: Irish Travellers are an indigenous ethnic minority population in Ireland, with poor life expectancy. This study aims to identify factors associated with reported discrimination and how this affects their experiences of accessing and quality of health services, including mental health. METHODS: The All Ireland Traveller Health Study was a cross-sectional census study in 2010. All Traveller families completed a survey questionnaire (n = 6540), and at random an adult selected from the family completed either a health status (health status study = 1547) or health services utilisation survey (HSU = 1576). Experience of discrimination (EOD) from the census was analysed in relation to HSU data on services used in the previous 12 months and reported experiences of access and quality of that health service. Census variables were analysed in relation to EOD and perceived discrimination (PD). RESULTS: In the final models, EOD and PD were significantly associated with socio-demographic, socio-cultural and living conditions. The multivariate odds of reporting EOD ranged from OR 1.84 to 2.13 and were significant for those reporting worse opportunities in accessing health services, mental health (p = 0.001), hospitals (p < 0.001) and public health nurses (p < 0.001). The multivariate odds of reporting EOD ranged from OR 1.95 to 2.71 and remained significant for those who reported they had poorer experiences than others when using health services, quality of experience (OR 2.18, p =< 0.001), trust in providers (OR 1.95, p =< 0.001) and appropriate information (OR 2.71, p =< 0.001). CONCLUSIONS: Travellers experience high levels of discrimination which negatively affects their engagement with health services. Culturally competent services need to be developed.

Performance analysis method for model-based irrigation strategies under uncertainty.

There is a necessity to increase the performance of food production in agriculture, this means, that precise management support in farming systems is required to reduce water use and drainage while avoiding crop stress. Management support based on model predictions is used to increase the performance of food production. However, sources of uncertainty affect the model predictions. Uncertainty in soil properties and uncertain evapotranspiration translate into uncertain predictions, and consequently in risk of performance loss. This paper presents the code and method to analyze performance uncertainty (and risk of performance loss) due to uncertain circumstances. The method is based on using the De Graaf evapotranspiration model and the EMMAN3G model, a Richards equation-based soil water model, as modules to conduct a performance uncertainty study.

Childhood central adiposity at ages 5 and 9 shows consistent relationship with that of the maternal grandmother but not other grandparents.

BACKGROUND: The importance of a life course approach to childhood obesity has been emphasized; however, few studies can prospectively investigate relationships in three-generation families. OBJECTIVE: To prospectively investigate the relationship between grandparental and grandchild waist circumference (WC) at ages 5 and 9 down maternal and paternal lines. METHODS: At baseline in the Lifeways Cross-Generation Cohort, 1094 children were born to 1082 mothers; 585 were examined at age 5 and 298 at age 9. Of the total 589 children with measured WC, data were also available from 745 grandparents. Child WC was standardized for age and sex, and theory-based hierarchical linear regression was used. RESULTS: Maternal grandmother (MGM) WC was predictive of grandchild WC at both time points. At age 5, grandchild's standardized birth weight (B = 0.266, p = 0.001), mother's means tested eligibility for free medical care (B = 1.029, p = 0.001) and grandchild seeing maternal grandparents daily (B = 0.312, p = 0.048) were significant alongside MGM WC (B = 0.015, p = 0.019). At age 9, only MGM WC (B = 0.022, p = 0.033) and mother's WC (B = 0.032, p = 0.005) were significant. Mediation analysis with mother's WC showed significant direct relationship of MGM and grandchild WC. CONCLUSIONS: This prospective cross-generational cohort shows consistent patterns of association between MGM and grandchild WC, not seen in other grandparental lineages.

Predictors of adults' body mass index and the association with index child's infant birth weight, in the Lifeways Cross-Generation Cohort Study of a thousand families in the Republic of Ireland.

The Lifeways study is novel in having information on three generations of the same families. It is well established that infant birth weight (IBW) predicts individuals' risk of adult chronic disease and more recently studies report cross-generation transmission of risk patterns. The aims of this analysis were to examine whether adults' birth weights were associated with measures of own health status or social position and to relate adults' birth weights to that of the index child's IBW. Finally, we assessed whether birth weight of either adults or children was associated with adult body mass index (BMI) of parents and grandparents. We included 1075 children whose IBW was recorded at recruitment from hospital records and 2546 adult cohort members followed from 2001 until 2014. At baseline, a sub-group of 920 adults had reported own birth weight (RBW). Results showed male adults' RBW were significantly higher than females' (P=0.001). Mothers' RBW was significantly correlated with IBW (r=0.178, P<0.001). In mixed effects linear models with BMI as the outcome variable, of all adults, and in sub-groups of adults with RBW and of mothers only, the IBW was associated with adult BMI adjusting for other predictors. Adults' BMI was positively associated with age (P=0.013), index child's IBW (P=0.001), gender (P<0.001) but not own RBW, adjusting for family identification number. When mothers were removed from the adult models however, IBW ceased to be associated with BMI, a final model showed RBW being associated with adult BMI (P=0.04). There are cross-generational associations in the Lifeways cohort, the maternal association being stronger.

A density functional approach to ferrogels.

Ferrogels consist of magnetic colloidal particles embedded in an elastic polymer matrix. As a consequence, their structural and rheological properties are governed by a competition between magnetic particle-particle interactions and mechanical matrix elasticity. Typically, the particles are permanently fixed within the matrix, which makes them distinguishable by their positions. Over time, particle neighbors do not change due to the fixation by the matrix. Here we present a classical density functional approach for such ferrogels. We map the elastic matrix-induced interactions between neighboring colloidal particles distinguishable by their positions onto effective pairwise interactions between indistinguishable particles similar to a 'pairwise pseudopotential'. Using Monte-Carlo computer simulations, we demonstrate for one-dimensional dipole-spring models of ferrogels that this mapping is justified. We then use the pseudopotential as an input into classical density functional theory of inhomogeneous fluids and predict the bulk elastic modulus of the ferrogel under various conditions. In addition, we propose the use of an 'external pseudopotential' when one switches from the viewpoint of a one-dimensional dipole-spring object to a one-dimensional chain embedded in an infinitely extended bulk matrix. Our mapping approach paves the way to describe various inhomogeneous situations of ferrogels using classical density functional concepts of inhomogeneous fluids.

Erratum: Structure and Dynamics of Loosely Cross-Linked Ionic Microgel Dispersions in the Fluid Regime [Phys. Rev. Lett. 109, 048302 (2012)].

This corrects the article DOI: 10.1103/PhysRevLett.109.048302.

A Prospective Analysis of the Relationship between Chronic Diseases and Adiposity in older adults: Findings from the Lifeways Cross-Generation Cohort Study of a Thousand Families 2001-2014.

This study assesses the relationship between body mass index (BMI) and adult chronic diseases (diabetes mellitus type 2 [DM2], cardiovascular diseases [CVD] and cancers), in grandparents in the Lifeways Cross-Generation Cohort Study. BMI was either measured or reported, at baseline or 10-year follow-up, in 1,244 grandparents. Cumulative morbidity data were recorded at baseline, 3 and 10-year follow-up through questionnaires, General Practice note search, or both. Just over 42% of grandparents were overweight and 32.1% obese. In the multivariate analysis BMI showed a strong linear association with both DM2 (ptrend <0.001) and CVD (ptrend <0.001). There were no significant associations with cancers, but case numbers were small. Results were similar for waist circumference. This prospective study presents novel Irish data and confirms other recent Irish cross-sectional reports on adiposity and adult chronic disease, highlighting the need for effective health promotion interventions in older adults.

Impact of primary healthcare providers' initial role security and therapeutic commitment on implementing brief interventions in managing risky alcohol consumption: a cluster randomised factorial trial.

BACKGROUND: Brief interventions in primary healthcare are cost-effective in reducing drinking problems but poorly implemented in routine practice. Although evidence about implementing brief interventions is growing, knowledge is limited with regard to impact of initial role security and therapeutic commitment on brief intervention implementation. METHODS: In a cluster randomised factorial trial, 120 primary healthcare units (PHCUs) were randomised to eight groups: care as usual, training and support, financial reimbursement, and the opportunity to refer patients to an internet-based brief intervention (e-BI); paired combinations of these three strategies, and all three strategies combined. To explore the impact of initial role security and therapeutic commitment on implementing brief interventions, we performed multilevel linear regression analyses adapted to the factorial design. RESULTS: Data from 746 providers from 120 PHCUs were included in the analyses. Baseline role security and therapeutic commitment were found not to influence implementation of brief interventions. Furthermore, there were no significant interactions between these characteristics and allocated implementation groups. CONCLUSIONS: The extent to which providers changed their brief intervention delivery following experience of different implementation strategies was not determined by their initial attitudes towards alcohol problems. In future research, more attention is needed to unravel the causal relation between practitioners' attitudes, their actual behaviour and care improvement strategies to enhance implementation science. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01501552.

Strategies in primary healthcare to implement early identification of risky alcohol consumption: why do they work or not? A qualitative evaluation of the ODHIN study.

BACKGROUND: Screening and brief interventions (SBI) in primary healthcare are cost-effective in risky drinkers, yet they are not offered to all eligible patients. This qualitative study aimed to provide more insight into the factors and mechanisms of why, how, for whom and under what circumstances implementation strategies work or do not work in increasing SBI. METHODS: Semi-structured interviews were conducted between February and July 2014 with 40 GPs and 28 nurses in Catalonia, the Netherlands, Poland, and Sweden. Participants were purposefully selected from the European Optimising Delivery of Healthcare Interventions (ODHIN) trial. This randomised controlled trial evaluated the influence of training and support, financial reimbursement and an internet-based method of delivering advice on SBI. Amongst them were 38 providers with a high screening performance and 30 with a low screening performance from different allocation groups. Realist evaluation was combined with the Tailored Implementation for Chronic Diseases framework for identification of implementation determinants to guide the interviews and analysis. Transcripts were analysed thematically with the diagram affinity method. RESULTS: Training and support motivated SBI by improved knowledge, skills and prioritisation. Continuous provision, sufficient time to learn intervention techniques and to tailor to individual experienced barriers, seemed important T&S conditions. Catalan and Polish professionals perceived financial reimbursement to be an additional stimulating factor as well, as effects on SBI were smoothened by personnel levels and salary levels. Structural payment for preventive services rather than a temporary project based payment, might have increased the effects of financial reimbursement. Implementing e-BI seem to require more guidance than was delivered in ODHIN. Despite the allocation, important preconditions for SBI routine seemed frequent exposure of this topic in media and guidelines, SBI facilitating information systems, and having SBI in protocol-led care. Hence, the second order analysis revealed that the applied implementation strategies have high potential on the micro professional level and meso-organisational level, however due to influences from the macro- level such as societal and political culture the effects risks to get nullified. CONCLUSIONS: Essential determinants perceived for the implementation of SBI routines were identified, in particular for training and support and financial reimbursement. However, focusing only on the primary healthcare setting seems insufficient and a more integrated SBI culture, together with meso- and macro-focused implementation process is requested. TRIAL REGISTRATION: ClinicalTrials.gov. Trial identifier: NCT01501552 .

Coupling between bulk- and surface chemistry in suspensions of charged colloids.

The ionic composition and pair correlations in fluid phases of realistically salt-free charged colloidal sphere suspensions are calculated in the primitive model. We obtain the number densities of all ionic species in suspension, including low-molecular weight microions, and colloidal macroions with acidic surface groups, from a self-consistent solution of a coupled physicochemical set of nonlinear algebraic equations and non-mean-field liquid integral equations. Here, we study suspensions of colloidal spheres with sulfonate or silanol surface groups, suspended in demineralized water that is saturated with carbon dioxide under standard atmosphere. The only input required for our theoretical scheme are the acidic dissociation constants pKa, and effective sphere diameters of all involved ions. Our method allows for an ab initio calculation of colloidal bare and effective charges, at high numerical efficiency.

Assessment of the cutaneous immune response during Arthroderma benhamiae and A. vanbreuseghemii infection using an experimental mouse model.

BACKGROUND: Dermatophytoses are common but poorly understood skin infections. Most in vivo studies have been performed using the guinea pig as the experimental animal model, which has several limitations. OBJECTIVES: To develop a mouse model of dermatophytosis suitable for multiple purposes, including the investigation of immunity against dermatophytes. MATERIALS AND METHODS: Two peculiar fungal species, Arthroderma benhamiae and A. vanbreuseghemii, isolated from tinea in humans having contact with rodents were used for epicutaneous inoculation. During the infection, clinical and histopathological follow-up were performed. The recruitment of immune cells was evaluated by immunofluorescence staining and the levels of cytokine mRNA were quantified by quantitative reverse transcriptase-polymerase chain reaction in the skin of infected mice. RESULTS: The skin symptoms and microscopic lesions, including the colonization of keratinized epidermal and follicular structures by both dermatophytes, were highly similar to those observed in guinea pig infection models and in natural infections, mimicking acute superficial tinea in humans. The dermal inflammatory cellular infiltrate consisted of macrophages, dendritic cells and especially polymorphonuclear neutrophils, which are one of the histological 'clues' to the diagnosis of dermatophytosis. The in situ cytokine profile was characterized by the overexpression of transforming growth factor-ß, interleukin (IL)-1ß and IL-6 mRNA during infection, suggesting a role of the T-helper 17 pathway in the establishment of immunity. CONCLUSIONS: Our new reproducible and validated mouse model of dermatophytosis is a modern in vivo tool that allows a more in-depth understanding of the pathogenesis of human dermatophyte infections.

Diabetes type II, other medical conditions and pancreatic cancer risk: a prospective study in The Netherlands.

BACKGROUND: To date, only a few risk factors for pancreatic cancer have been established. We examined prospectively relations between several medical conditions and pancreatic cancer incidence. METHODS: In 1986, 120 852 participants completed a baseline questionnaire on cancer risk factors, including several self-reported physician diagnosed medical conditions. At baseline, a random subcohort of 5000 participants was selected using a case-cohort approach for analysis. After 16.3 years of follow-up, 448 pancreatic cancer cases (63% microscopically confirmed) were available for analysis. RESULTS: Diabetes mellitus type II and hepatitis were positively associated with pancreatic cancer risk (multivariable-adjusted hazard ratio: 1.79; 95% confidence interval: 1.12-2.87 and hazard ratio: 1.37; 95% confidence interval: 1.04-1.81, respectively). Furthermore, a positive trend in risk with increasing years of diagnosis of diabetes (P=0.004) and of hepatitis (P=0.02) was observed. However, an inverse association was observed between hypertension and pancreatic cancer risk, this was found among microscopically confirmed cases only (hazard ratio: 0.66; 95% confidence interval: 0.49-0.90), while years since diagnosis of hypertension significantly decreased cancer risk (P for trend=0.02). CONCLUSION: In this prospective study, a positive association was observed between self-reported physician diagnosed diabetes mellitus type II and hepatitis and pancreatic cancer risk, whereas an inverse association was observed with hypertension.

[Reducing fragmentation in the care of frail older people: the successful development and implementation of the Health and Welfare Information Portal]. / Het verminderen van fragmentatie in de zorg voor kwetsbare ouderen: de succesvolle ontwikkeling en implementatie van het Zorg en WelzijnsInfoPortaal.

Our fragmented health care systems are insufficiently equipped to provide frail older people with high quality of care. Therefore, we developed the Health and Welfare Information Portal (ZWIP), an e-health intervention which aims (1) to facilitate self-management by frail older people and informal caregivers and (2) to improve collaboration among professionals. The ZWIP is a personal conference table, accessible through a secure internet connection, for multidisciplinary communication and information exchange for frail older people, their informal caregivers and professionals. After development, the ZWIP was implemented in seven general practices, and this process was evaluated by means of a mixed-methods study. Eventually, 290 frail older people and 169 professionals participated in the ZWIP. Most professionals were positive about its implementation. Facilitators for the implementation were the experienced need for improvement of interprofessional collaboration and the user-friendliness of the ZWIP. Barriers were the low computer-literacy of frail older people, start-up problems, preferring personal contact, and limited use of the ZWIP by other professionals. In sum, this article describes the successful development and implementation of the ZWIP, an e-health intervention which can reduce fragmentation in the care of frail older people.

Structure and dynamics of loosely cross-linked ionic microgel dispersions in the fluid regime.

We report a comprehensive experimental-theoretical study of the temperature- and concentration-dependent swelling behavior of weakly cross-linked PNiPAm ionic microgel particles in the deionized fluid phase. The particles swell reversibly when the dispersion is cooled from the collapsed state to lower temperatures. While the collapsed state shows no dependence on the microgel number density, the swelling at lower T is more pronounced at lower concentrations. The static pair correlations and short-time diffusion functions, and the concentration and temperature dependence of the microgel radius and effective charge, are studied using static and dynamic light scattering in combination with state-of-the-art analytical theoretical schemes based on a Yukawa-type effective pair potential and a core-shell model. We show that only such a combined, simultaneous fit of static and dynamic scattering functions allows for an unambiguous determination of the microgel radius and effective charge.

Radiation boundary conditions for the numerical solution of the three-dimensional time-dependent Schrödinger equation with a localized interaction.

Exact radiation boundary conditions on the surface of a sphere are presented for the single-particle time-dependent Schrödinger equation with a localized interaction. With these boundary conditions, numerical computations of spatially unbounded outgoing wave solutions can be restricted to the finite volume of a sphere. The boundary conditions are expressed in terms of the free-particle Green's function for the outside region. The Green's function is analytically calculated by an expansion in spherical harmonics and by the method of Laplace transformation. For each harmonic number a discrete boundary condition between the function values at adjacent radial grid points is obtained. The numerical method is applied to quantum tunneling through a spherically symmetric potential barrier with different angular-momentum quantum numbers l . Calculations for l=0 are compared to exact theoretical results.

Sedentary patients with venous or mixed leg ulcers: determinants of physical activity.

AIM: This paper is a report of a study to identify the determinants of physical activity (PA) in patients with venous leg ulcers to develop recommendations for behavioural interventions aimed at enhancing physical activity. BACKGROUND: Physical activity promotes wound healing and prevents the recurrence of wounds in venous patients with leg ulcers. Many patients with leg ulcers, however, have a sedentary lifestyle. METHOD: A random sample of 25 patients from two clinics were interviewed in 2003 using a combination of prestructured and open-ended questions. All these patients were being treated at an outpatient dermatology clinic and had a leg ulcer with venous or mixed aetiology at the time of the interview or in the month prior to the interview. FINDINGS: Only nine of the 25 patients (36%) reported sufficient levels of moderate strenuous physical activity, defined as 30 minutes a day on at least 5 days a week. The results show limited knowledge about the relationship between physical activity and leg ulceration, and low self-efficacy for increasing physical activity. In addition, multi-morbidity, pain and social support were identified as main determinants of physical activity. CONCLUSION: Suggestions for improving physical activity levels include influencing knowledge, beliefs and self-efficacy. Patient's individual physical limitations, pain, adequate footwear and social support should be taken into account. Programmes offered by specialized dermatology nurses to stimulate physical activity might fulfil patient needs and help enhance physical activity levels.

Bridge-bonded formate: active intermediate or spectator species in formic acid oxidation on a Pt film electrode?

We present and discuss the results of an in situ IR study on the mechanism and kinetics of formic acid oxidation on a Pt film/Si electrode, performed in an attenuated total reflection (ATR) flow cell configuration under controlled mass transport conditions, which specifically aimed at elucidating the role of the adsorbed bridge-bonded formates in this reaction. Potentiodynamic measurements show a complex interplay between formation and desorption/oxidation of COad and formate species and the total Faradaic current. The notably faster increase of the Faradaic current compared to the coverage of bridge-bonded formate in transient measurements at constant potential, but with different formic acid concentrations, reveals that adsorbed formate decomposition is not rate-limiting in the dominant reaction pathway. If being reactive intermediate at all, the contribution of formate adsorption/decomposition to the reaction current decreases with increasing formic acid concentration, accounting for at most 15% for 0.2 M DCOOH at 0.7 VRHE. The rapid build-up/removal of the formate adlayer and its similarity with acetate or (bi-)sulfate adsorption/desorption indicate that the formate adlayer coverage is dominated by a fast dynamic adsorption-desorption equilibrium with the electrolyte, and that formate desorption is much faster than its decomposition. The results corroborate the proposal of a triple pathway reaction mechanism including an indirect pathway, a formate pathway, and a dominant direct pathway, as presented previously (Chen, Y. X.; et al. Angew. Chem. Int. Ed. 2006, 45, 981), in which adsorbed formates act as a site-blocking spectator in the dominant pathway rather than as an active intermediate.

The effects of recall on reporting injury and poisoning episodes in the National Health Interview Survey.

OBJECTIVE: To examine effects of length of time between injury or poisoning and interview on the number of reported injury and poisoning episodes in the National Health Interview Survey (NHIS). (Hereinafter, both injuries and poisonings will be referred to as "injuries".) DESIGN: The NHIS collects data continuously on medically attended injuries occurring to family members during the three months before interview. Time between injury and interview was established by subtracting the reported injury date from the interview date. Values were multiply imputed for the 25% of the episodes for which dates were only partially reported. MAIN OUTCOME MEASURES: An analysis of mean square error (MSE) was used to quantify the extent of errors in estimated annual numbers of injuries and to compare the contributions of bias and variance to these errors. RESULTS: The lowest estimated MSEs for annualized estimates for all injuries and for less severe injuries were attained when the annualized estimates were based on 3--6 elapsed cumulative weeks between injury and interview. The average weighted number of injuries reported per week per year was 8% lower in later weeks (weeks 6--13) than in earlier weeks (weeks 1--5) for all episodes, and 24% lower in later weeks than in earlier weeks for contusions/superficial injuries, with both differences being statistically significant. For fractures, however, the averages in the two periods were statistically similar. CONCLUSIONS: The error associated with the estimated annual number of injuries was large with a three month reference period for all injuries and for less severe injuries. Limiting analysis to episodes with up to five weeks between injury and interview has statistical, intuitive, and analytic appeal for all injuries and for less severe injuries.

Applying ICF in nursing practice: classifying elements of nursing diagnoses.

AIM: This study explores the relevance of the International Classification of Functioning, Disability and Health (ICF) to nursing diagnoses. BACKGROUND: As a multidisciplinary classification of human functioning, the ICF (previously known as ICIDH-2) is potentially relevant to nursing care. However, nurses have rarely used the classification during the 23 years of its existence. METHOD: In part 1 of the study, 51 nursing diagnoses from anonymous patients were deliberately selected for diversity from an existing database. The 427 diagnostic elements from these diagnoses (problem statements, aetiological factors, signs and symptoms) were classified, using the ICF, by a panel of six nurses. In part 2 of the study, the panel classified 223 elements from 30 diagnoses of patients they had actually cared for. RESULTS: Nearly all diagnostic elements could be classified, most often in the sub-dimensions of body functions and activities. Agreement on appropriate ICF components was 61% for anonymous patients and 75% for familiar patients. Agreement at the more detailed 3-digit level of the classification was 42% for anonymous and 60% for familiar patients. CONCLUSION: The ICF has relevance to nursing care. As a general classification, it was not designed by nurses or specifically for nursing care. This can explain some difficulties in using the classification that were identified in this study, as well as the rather low levels of agreement. To resolve these issues and to further improve the classification, nurses should further explore the use of the ICF and participate in future revision processes.