Health and happiness is more important than weight': a qualitative investigation of the views of parents receiving written feedback on their child's weight as part of the National Child Measurement Programme.

BACKGROUND: The present study aimed to explore parental perceptions of overweight children and associated health risks after receiving National Child Measurement Programme (NCMP) weight feedback. METHODS: Fifty-two parents of overweight and obese children aged 4-5 years and 10-11 years enrolled in the NCMP programme in England in 2010-2011 participated in qualitative, semi-structured interviews about their perceptions of their child's weight and health risk after receiving weight feedback. Interviews were audio tape recorded and were conducted either by telephone (n = 9) or in the respondents' homes (n = 41). Interviews were transcribed verbatim and analysed using interpretative thematic analysis. RESULTS: Parents who received NCMP written feedback informing them that their child was overweight disregarded the results because they viewed 'health and happiness as being more important than weight'. The feedback was viewed as less credible because it did not consider the individual child's lifestyle.'Broad definitions of healthy' were described that did not include weight,such as reference to the child having good emotional and physical health and a healthy diet. Parents attributed weight to 'inherited/acquired factors' such as genetics or puppy fat, or did not regard their child's 'appearance' as reflecting being overweight. 'Cultural influence' also meant that being overweight was not viewed negatively by some non-white parents. CONCLUSIONS: After receiving written weight feedback, parents use methods other than actual weight when evaluating their child's weight status and health risks. Parents' conceptions of health and weight should be considered when communicating with parents, with the aim of bridging the gap between parental recognition of being overweight and subsequent behaviour change.

General outbreaks of infectious intestinal disease linked with poultry, England and Wales, 1992-1999.

Between 1992 and 1999, 1426 foodborne general outbreaks of infectious intestinal disease (IID) were reported to the Public Health Laboratory Service Communicable Disease Surveillance Centre. A fifth were associated with the consumption of poultry. Chicken was implicated in almost three quarters of these outbreaks, turkey in over a fifth and duck in 2% of outbreaks. The organisms most frequently reported were Salmonella (30% of outbreaks), Clostridium perfringens (21%) and Campylobacter (6%). Over 7000 people were affected, with 258 hospital admissions and 17 deaths. During the summer, outbreaks were mainly of salmonellosis and attributed to the consumption of chicken. In December, C. perfringens and turkey were the organism and vehicle most often implicated. Most outbreaks occurred on commercial catering premises (56%) or in private houses (21%). The highlight of this surveillance period was the fall in outbreaks of salmonellosis linked with poultry products, probably due, at least in part, to the vaccination of poultry flocks.

Needing to know? Ethical dilemmas in leprosy treatment and control.

A young man presents to your local clinic in a leprosy endemic country with a small patch of discoloured skin on his right forearm. The diagnosis is clear. You start to explain, but the man stops you: he doesn't want to hear more, just requests the medicine. But you are 'in conflict', and not just by the desire to discuss the situation more fully with your patient before prescribing a drug. The local public health team, of which you are a part, is currently evaluating the impact on the community's health of a patient education programme which necessitates informing all new leprosy cases of their diagnosis. What should you do? And can bio-ethics help?

Evaluation of the unlinked anonymous prevalence monitoring programme for HIV in England and Wales: science, ethics and health policy.

BACKGROUND: The Unlinked Anonymous Prevalence Monitoring Programme for HIV in England and Wales was set up in 1989 and has been operational for over a decade. This paper describes a wide-ranging evaluation of the programme encompassing different perspectives and approaches: epidemiological, ethical, social scientific and economic. MATERIAL AND METHODS: Epidemiological and ethical evaluation by critical review of the literature. Evaluation of the public's views on unlinked anonymous testing of blood by questions inserted into the Omnibus National Survey carried out by the Office for National Statistics. Evaluation of the views of planners of HIV/AIDS services by telephone questionnaire survey. Economic analysis by costing of the programme. RESULTS: Epidemiologically the programme's results contribute to the jigsaw of knowledge about HIV. The ethical debate has shifted with time, and moral justification for the programme was more valid at its inception than now. The majority of the public was unaware of unlinked anonymous testing of blood for HIV, and 25-30% disagreed with the policy. Local planners of HIV services found the programme generally useful. There are concerns about the programme's hidden costs and funding. CONCLUSIONS: To improve awareness and respect autonomy information leaflets, explaining opting out of testing, should be handed to all individuals at centres where the programme is operational. Data from the programme should be fed back quicker to local planners, and the programme's funding needs reappraisal. Further research on patients' views is indicated. Generic conclusions include the need for a definition of 'public health emergency', and establishment of a national healthcare ethics committee.

The 'redefinition of death' debate: western concepts and western bioethics.

Biomedicine is a global enterprise constructed upon the belief in the universality of scientific truths. However, despite huge scientific advances over recent decades it has not been able to formulate a specific and universal definition of death: In fact, in its attempt to redefine death, the concept of death appears to have become immersed in ever increasing vagueness and ambiguity. Even more worrisome is that bioethics, in the form of principlism, is also endeavouring to become a global enterprise by claiming neutrality. It appears that the discourse within both disciplines have similarly manipulated the boundaries of death to include the "dying". This paper argues that the redefinition of death debate in biomedicine reveals a concept of personhood which is profoundly western in origin and which is in accordance to the concept adhered to within principlism. Biomedicine and bioethics do not appear to acknowledge the limitations of their own world view and hence lack an understanding of their applicability and appropriateness in diverse social and cultural contexts; a situation which adds credence to claims as to the hegemonic and imperialistic nature of all such global enterprises.

Not listening to patients--the use and misuse of patient satisfaction studies.

Demand for the development of health services that are responsive to the views of users has led to a growing interest in the measurement of patient satisfaction. Initial reluctance to seek the views of users of mental health services focused on a debate about whether or not mentally disordered patients were able to make 'valid' comments about their treatment. More recently the development of questionnaires that claim to 'reliably measure' the views of patients have coincided with a greater acceptance of the role that such studies can play. However, it is argued that the use of these quantitative and often simplistic methods underestimate the dissatisfaction of many patients. Further exploration of the differing expectations of users and providers of services and a degree of willingness in both parties to change is required if services are to be developed that better meet the needs of patients.

Usefulness of information from the unlinked anonymous prevalence monitoring programme for HIV in England and Wales: survey of planners of HIV/AIDS services.

The aim of this study was to evaluate whether information from the Unlinked Anonymous Prevalence Monitoring Programme for HIV in England and Wales is useful to planners of HIV/AIDS services. The study involved 2 stages: examination of 1997 AIDS Control Act Reports for England and Wales, and a telephone questionnaire survey of local planners of HIV/AIDS services. Forty-eight out of 55 health authorities (87.3%) found information from the programme to be useful in general; 37/55 (67.3%) found the information useful for targeting of health promotion; 35/55 (63.6%) found the information useful for assessing the effectiveness of preventive measures aimed at reducing the spread of HIV; and 28/55 (50.9%) found the information useful for planning of medical or social services. If information from the programme was no longer available, 36/55 (65.5%) said it would make some difference to local planning, although 12/55 (21.8%) said it would make no difference. Local planners were generally supportive of the programme, and complaints were mostly directed at funding and timeliness of the reports.

Advance directives in the UK: legal, ethical, and practical considerations for doctors.

In the United Kingdom (UK), advance directives have recently received considerable attention from professional and voluntary organizations as well as medical journals and the media. However, despite such exposure, many doctors remain uncertain of the importance or relevance of advance directives with regard to their own clinical practice. This paper addresses these uncertainties by first explaining what advance directives are and then describing the current legal status of such directives in the UK. Examination of the cases underpinning this status reveals several key elements: competence, information, anticipation, applicability, and freedom from duress. Each is discussed. Although this paper focuses on legal issues, it is important that medical law does not dominate medical ethics. Accordingly, the paper also discusses some important philosophical and sociological considerations that have remained largely unexplored in the medical press. Finally, the paper deals with practical matters, including how the general practitioner might be involved.

On failing to understand informed consent.

Many doctors view informed consent as merely a medicolegal concept. This article points out that other discourses are possible and that patients would benefit if doctors were to take a wider view.