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We investigated the association between sedentary behavior (SB) and wish to die (WTD; i.e., feeling that one would be better off dead or wishing for one's own death), and the extent to which this can be explained by sleep problems, depression, anxiety, loneliness, perceived stress, and social network in a nationally representative sample of adults aged ≥50 years from Ireland. Cross-sectional data from Wave 1 of the Irish Longitudinal Study on Ageing 2009-2011 were analyzed. WTD was defined as answering affirmatively to the question "In the last month, have you felt that you would rather be dead?" SB was used as a continuous variable (hours/day), and also as a categorical (< or ≥8 h/day) variable. Multivariable logistic regression and mediation analyses were conducted. Data on 8163 adults aged ≥50 years were analyzed [mean (SD) age 63.6 (9.1) years; 48.0% males]. Overall, ≥8 (vs. <8) hours/day of SB was associated with a significant 2.04 (95%CI = 1.50-2.76) times higher odds for WTD, while a 1-h increase in SB per day was associated with 1.11 (95%CI = 1.06-1.16) times higher odds for WTD. Mediation analysis showed that sleep problems, depression, loneliness, perceived stress, and social network explained a modest proportion of the association between SB and WTD (mediated percentage 9.3%-14.8%). The present cross-sectional study found that increasing or higher levels of SB is positively associated with WTD. Addressing the identified potential mediators may reduce WTD among people who are sedentary. However, future longitudinal and intervention studies are needed to make concrete recommendations.
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GP training in the UK has a long history of success, however that is measured. That success is in part due to the formality and credentialling that underlies preparation to take on that role of a GP teacher, which is somewhat under current threat due to workforce pressures. We identify three important factors associated with the GP trainer function [leadership, professional identity and clinical care improvement] that are not often analysed but are at some risk if preparation for the GP trainer role is reduced or devalued. Of particular note are the differing ways that GPs conceptualise their professional roles as teachers and clinicians, despite the transferable skills between them, the demonstrably improved patient care that occurs in practices that teach, and the necessary connections between educational theory and practice. We suggest that these areas define a research agenda ripe for exploration.
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BACKGROUND/AIMS: Good knowledge, Attitude, and Practice (KAP) of diabetes influence its control and complications. We examined the KAP of diabetes in patients with sight-threatening diabetic retinopathy (STDR) and non-sight-threatening diabetic retinopathy (NSTDR) attending two different referral hospitals in India. METHODS: 400 consecutive patients (mean age = 58.5 years ± 10.3) with diabetic retinopathy attending retina referral clinics in Chennai (private) and Darjeeling (public) were recruited. A validated questionnaire on diabetic KAP was administered in English or the local language. Data were analysed using an established scalar-scoring method in which a score of 1 was assigned to the correct answer/healthy lifestyle and 0 to an incorrect answer/unhealthy lifestyle/practice. Clinical data included fasting blood sugar, blood pressure, retinopathy, and visual acuity. Retinopathy was graded as STDR/NSTDR from retinal images using Early Treatment of Diabetic Retinopathy Study criteria. RESULTS: Usable data from 383 participants (95.8%) were analysed. Of these, 83 (21.7%) had STDR, and 300 (78.3%) had NSTDR. The NSTDR group reported a significantly lower total KAP score (mean rank = 183.4) compared to the STDR group (mean rank = 233.1), z = -3.0, p < 0.001. A significantly greater percentage in the NSTDR group reported to being unaware that diabetes could affect eyes, did not know about possible treatment for DR, and checked their blood sugar less frequently than once a month. CONCLUSION: Patients who had not developed STDR had poorer KAP about diabetes and diabetes-related eye diseases. This is an important issue to address as the risk of their progressing to STDR is high unless appropriate steps to improve their knowledge/awareness and lifestyle practice are introduced early.
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Diabetes Mellitus Tipo 2 , Retinopatía Diabética , Enfermedades de la Retina , Humanos , Persona de Mediana Edad , Retinopatía Diabética/epidemiología , Retinopatía Diabética/etiología , Glucemia , Conocimientos, Actitudes y Práctica en Salud , India/epidemiología , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/terapiaRESUMEN
The development of high-quality clinicians takes place through immersion in clinical practice facilitated by educational supervisors with appropriate capabilities and organisational support to undertake the role. Learners give feedback on the quality of their learning experience on placement, which provides insights about the quality of clinical care received by patients.In this article, we explore the role of educational leaders in engaging with learner feedback about patient care, the challenges and tensions this generates, and the path through resolution. We use a lived example to showcase the issues raised and offer reflections on the challenges faced.
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The philosophical underpinnings of primary care have been examined from several perspectives in recent years. In two previous articles, we have argued that a relational view of autonomy is better matched to the primary care setting than others, and that view is mainly formed from the descriptors of its practice. Here we develop that analysis further, linking it to other relevant theory: the experience of human suffering and epistemic injustice. We argue that relational care is fundamental to ameliorating epistemic injustice and that relationships are integral to ethical practice, rather than being distinct. We propose that personalised care as described in the NHS Long Term Plan is not possible without addressing epistemic injustice and therefore without reconsidering our existing normative ethical frameworks.
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BACKGROUND: In the UK, the Certificate of Vision Impairment (CVI) certifies a person as sight impaired (partially sighted) or severely sight impaired (blind). This is completed by ophthalmologists and passed with the patient's consent to their GP, their local authority, and The Royal College of Ophthalmologists Certifications office. Once a person is certified, they can be registered by their local authority which is voluntary but enables the person to access rehabilitation or habitation services, financial concessions, welfare benefits and other services provided by local authorities. METHODS: We conducted semi-structured individual interviews with 17 patients with a diagnosed eye condition, 4 Eye Clinic Liaison Officers (ECLO) and 4 referring optometrists around their experiences around CVI and registration processes. Analysis of themes was conducted with results synthesised in a narrative analysis. RESULTS: Patients reported lack of clarity around the processes of certification and registration, benefits of certification and what happens beyond certification, the type of support that they are entitled to, delays in accessing support. Optometrists appear not to engage with the process much, especially if the patient is being treated by the hospital eye service. CONCLUSION: Vision loss can be a devastating experience for the patient. There is a lack of information and confusion around the process. The lack of a joined-up process between certification and registration needs to be addressed if we are to provide the support that patients deserve in order to improve their quality of life and wellbeing.
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Optometristas , Calidad de Vida , Humanos , Trastornos de la Visión/diagnóstico , Trastornos de la Visión/terapia , Certificación , Agudeza VisualRESUMEN
We have published a model in which biomedical and humanistic elements of the consultation are seen as complementary and where hermeneutics, the discovery and creation of meaning, plays an integral role in enriching conversations both between clinicians and patients and also between teachers and learners. We have also proposed that hermeneutics can be particularly powerful in exploring and making explicit elements of the hidden curriculum. In this article, we consider how hermeneutics can be applied in primary care training and supervision, in order to enhance the experience for both teacher and learner.
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Educación Médica , Comunicación , Curriculum , Hermenéutica , Humanos , Atención Primaria de SaludRESUMEN
We have published a model of the GP consultation where biomedical and humanistic elements of the consultation are seen as complementary and where hermeneutics, the discovery and creation of meaning, plays an integral role in enriching the conversation between clinicians and patients. The relationship between teachers and learners shows strong parallels with the relationship between practitioners and patients. We therefore explore how a similar analysis can enhance the relationship between teachers and learners and propose that hermeneutics can be particularly powerful in exploring and making explicit elements of the hidden curriculum.
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Educación Médica , Curriculum , Hermenéutica , HumanosRESUMEN
In this article, we examine the inter-relationship between moral theory and the unpredictable and complex world of primary health care, where the values of patient and doctor, or groups of patients and doctors, may often clash. We introduce complexity science and its relevance to primary care; going on to explore how it can assist in understanding ethical decision making, as well as considering implications for clinical practice. Throughout the article, we showcase aspects and key concepts using examples and a case study developed from our day-to-day experience working as clinical practitioners in primary care.
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Principios Morales , Médicos , Toma de Decisiones , Teoría Ética , Humanos , Atención Primaria de SaludRESUMEN
INTRODUCTION: Previous research has highlighted the benefits of receiving care in a postgraduate GP training practice including improved patient satisfaction, more appropriate secondary care usage, cancer diagnosis, and antibiotic prescribing. Whilst the influence of being registered in a postgraduate GP training practice on patient outcomes is modest relative to other factors such as deprivation, disease burden, demography, and ethnicity, the reasons for this benefit is not clear. AIM: This study explores how GP trainers perceive engagement with clinical education influences patient care. METHODS: Socio-cultural theories were used as a framework for guiding the research. Semi-structured interviews were conducted with 11 GP educators. Interviews were recorded and transcribed verbatim. Data analysis involved thematic analysis. RESULTS: GP educators identified four overarching themes that, for them, seemed to explain how clinical education mediates its influence on patient care. These included: influencing through (i) educational leadership; (ii) learners; (iii) the educational process; and (iv) educational standards. DISCUSSION: Findings suggest that GP trainees have a significant effect on the learning environment, professional development of GP trainers, and patient care. The nature of the relationship between GP trainers and trainees appears far more bilateral than acknowledged in the apprenticeship model.
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Médicos Generales/educación , Atención al Paciente/métodos , Adulto , Actitud del Personal de Salud , Femenino , Medicina General/métodos , Médicos Generales/normas , Humanos , Internado y Residencia , Masculino , Persona de Mediana Edad , Atención al Paciente/normas , Investigación Cualitativa , EnseñanzaRESUMEN
The General Medical Council (GMC) has called upon the Royal Postgraduate Medical Colleges to redesign their curricula using principles of capability. This offers an opportunity to better align the General Practice training curriculum with the role of the general practitioner, and we argue that approaches have already been developed that may be adapted to support the teaching and assessment of capability. We set out our understanding of how capability differs from competency, in particular how the former emphasises the ongoing creation of everyday knowledge within clinical practice. We offer an expanded version of capability comprising a prospective disposition towards noticing and responding to novelty. We offer some suggestions around how capability can be developed: through heightened sensitivity to context, development of divergent thinking and assessment of zones of professional practice. We emphasise the role of the supervisor in helping to support these dispositions through an appreciative, and collaborative, approach that acknowledges the full range of reasonable decisions applicable to each particular context.