Lifestyle Behaviours Add to the Armoury of Treatment Options for Panic Disorder: An Evidence-Based Reasoning.

This article presents an evidence-based reasoning, focusing on evidence of an Occupational Therapy input to lifestyle behaviour influences on panic disorder that also provides potentially broader application across other mental health problems (MHP). The article begins from the premise that we are all different. It then follows through a sequence of questions, examining incrementally how MHPs are experienced and classified. It analyses the impact of individual sensitivity at different levels of analysis, from genetic and epigenetic individuality, through neurotransmitter and body system sensitivity. Examples are given demonstrating the evidence base behind the logical sequence of investigation. The paper considers the evidence of how everyday routine lifestyle behaviour impacts on occupational function at all levels, and how these behaviours link to individual sensitivity to influence the level of exposure required to elicit symptomatic responses. Occupational Therapists can help patients by adequately assessing individual sensitivity, and through promoting understanding and a sense of control over their own symptoms. It concludes that present clinical guidelines should be expanded to incorporate knowledge of individual sensitivities to environmental exposures and lifestyle behaviours at an early stage.

Development of the Thai version of Mini-Cog, a brief cognitive screening test.

AIMS: Cognitive impairment, such as dementia, has emerged as the leading public health problem among the elderly. Therefore, early detection of the disorder and providing appropriate healthcare and management is important, particularly, for the patients with comorbid diabetes who require long-term treatment strategies. In Thailand, because of a large number of elderly patients with diabetes, and time constraints in primary care settings, a short and effective cognitive screening test is required. The Mini-Cog is a short and valid cognitive screening test that was specifically designed for use in primary care settings. The present study translated the English language version into a Thai language version, and then measured the interrater reliability and concurrent validity. METHODS: The processes of cross-language translation were carried out to develop a Thai language version of the Mini-Cog. A total of 21 Thai older adults with type 2 diabetes with a mean aged of 69 ± 7 years were recruited into a study investigating the interrater reliability and concurrent validity of the Mini-Cog Thai version in one primary care center in Thailand. RESULTS: The Mini-Cog Thai version showed a good interrater reliability (K = 0.80, P < 0.001, 95% CI 0.50-1.00) and a positive concurrent validity (r = 0.47, P = 0.007, 95% CI 0.37,0.55) with the Mini-Mental State Examination Thai 2002. CONCLUSIONS: The findings show that the Thai version of the Mini-Cog is a reliable, performance-based tool in the screening for cognitive function in primary care settings in Thailand. It is recommended that it could be used as a new cognitive screening test for the aging population in the Thai community.

A cost-minimisation study of 1,001 NHS Direct users.

BACKGROUND: To determine financial and quality of life impact of patients calling the '0845' NHS Direct (NHS Direct) telephone helpline from the perspective of NHS service providers. METHODS: Cost-minimisation of repeated cohort measures from a National Survey of NHS Direct's telephone service using telephone survey results. 1,001 people contacting NHS Direct's 0845 telephone service in 2009 who agreed to a 4-6 week follow-up. A cost comparison between NHS Direct recommendation and patient-stated first alternative had NHS Direct not been available. Analysis also considers impact on quality of life of NHS Direct recommendations using the Visual Analogue Scale of the EQ-5D. RESULTS: Significant referral pattern differences were observed between NHS Direct recommendation and patient-stated first alternatives (p < 0.001). Per patient cost savings resulted from NHS Direct's recommendation to attend A&E (£36.54); GP Practice (£19.41); Walk-In Centre (£49.85); Pharmacist (£25.80); Dentist (£2.35) and do nothing/treat at home (£19.77), while it was marginally more costly for 999 calls (£3.33). Overall an average per patient saving of £19.55 was found (a 36% saving compared with patient-stated first alternatives). For 5 million NHS Direct telephone calls per year, this represents an annual cost saving of £97,756,013. Significant quality of life differences were observed at baseline and follow-up between those who believed their problem was 'urgent' (p = 0.001) and those who said it was 'non-urgent' (p = 0.045). Whilst both groups improved, self-classified 'urgent' cases made greater health gains than those who said they were 'non-urgent' (urgent by 21.5 points; non-urgent by 16.1 points). CONCLUSIONS: The '0845' service of NHS Direct produced substantial cost savings in terms of referrals to the other parts of the NHS when compared with patients' own stated first alternative. Health-related quality of life also improved for users of this service demonstrating that these savings can be produced without perceived harm to patients.

Can weight-related health risk be more accurately assessed by BMI, or by gender specific calculations of Percentage Body Fatness?

The problem of obesity over the last 10 years has consistently been referred to as a 'global epidemic'. The Body Mass Index (BMI) is the currently accepted measure for classifying weight-related risk, but is a crude measure that has not changed in 150 years. It is recognised as having significant limitations, largely due to its lack of distinction between fat and muscle tissue. As the health risks of obesity are linked to the fat content of the body, a more accurate method of classifying would be Percentage Body Fatness (PBF). Although skinfold thickness analysis is recognised as a valid and accurate estimate of PBF in field studies, this method is not routinely used in clinical practice. Using data collected from young adults in the United Kingdom, we compared classifications (underweight, normal weight, overweight and obese) using BMI, with classifications using estimated PBF (from skinfold thickness analysis). We identified disparity between these two methods in approximately 1/3 of participants. BMI correctly classified 66.5% of females and 62.7% of males, with different gender profiles of incorrect classification. Regression analysis was conducted using estimated PBF (by skinfold thickness analysis) as the dependent variable, with explanatory variables of age, height, weight, systolic blood pressure, frequency of vigorous exercise and grip strength. The resulting gender-specific formulae derived from this regression analysis provides a regression R(2) of around 65%, and improved correct classifications to 74% for females and 76% for males. This represents an average improvement of roughly ten percentage points over BMI (male: 7.2% points; female: 13.4% points). We hypothesise that the presented formulae provide gender-specific calculations of PBF, which result in a more accurate indicator of weight-related health risk, compared with BMI in this population. This provides a new approach to an increasingly important clinical issue. These formulae use data that can be easily, quickly and cost-effectively measured in a practice setting. If shown to be repeatable with larger and more diverse populations, the PBF formulae could provide an alternative to the BMI as the major indicator of body-composition related health risk. This would ensure resources are targeted more appropriately and efficiently.