Health and lifestyle advisors in support of primary care: An evaluation of an innovative pilot service in a region of high health inequality.

INTRODUCTION: A health and lifestyle advisor service embedded within primary care was piloted in Kingston-upon-Hull from January 2021. We aimed to evaluate the first two years of service delivery by identifying patient demographics referred to the service, reason for referral, determine uptake and retention rates, and monitor individual lifestyle-related risk factor changes following discharge. METHODS: Anonymised data were extracted from the SystmOne database for all patients referred to the service between January 2021 and January 2023. RESULTS: In the initial two years of the service, 705 unique patients were referred at a mean rate of ∼29 per month. Each unique patient received a median (robust median absolute deviation; [MAD]) of 3 (Steel N, et al 2018) planned consultations prior to discharge over this period. The majority of referrals were for symptom management and health promotion purposes (95%). Of those referred, 69% attended their appointments, and 14% did not attend. The majority of referrals were white British (55%), however, the service did receive a substantial number of referrals from minority ethnic groups, with only 67% of referrals speaking English as their main language. Eighteen distinct languages were spoken. Most referrals were classified as class I obese (59.4%). Across initial and final appointments, median (robust MAD) systolic blood pressure was 130 (15) mmHg and 130 (15) mmHg, and median (robust MAD) waist circumference was 103.0 (13.3) cm and 101.0 (13.3) cm. CONCLUSION: The evaluation highlighted the demand for this service embedded within primary care settings in Kingston-upon-Hull. Service engagement was evident, and a large proportion of those who engaged were from minority ethnic groups. A high proportion of referrals presented with obesity and/or hypertension which requires further investigation.

"I Hear the Music and My Spirits Lift!" Pleasure and Ballroom Dancing for Community-Dwelling Older Adults.

Physical activity for older adults is recommended to encourage the maintenance of functional autonomy and improve mental health. Ballroom dancing involves aerobic, strength, and balance work and is an inherently a social activity. This 12-month qualitative study considered the influence of ballroom dancing on health and well-being in community-dwelling older adults. It explores an underreported aspect of physical activity, which may incentivize older people to participate, that is, pleasure. Qualitative data were managed and analyzed using the Framework Analysis approach. Semistructured interviews were conducted with 26 older adult ballroom dancers. Five typologies of pleasure were identified. In addition to "sensual pleasure," "pleasure of habitual action," and "pleasure of immersion," as suggested by Phoenix and Orr, the "pleasure of practice" and "pleasure of community" were also identified. Ballroom dancing produces a strong sense of embodied pleasure for older adults and should be promoted by health and exercise professionals for community-dwelling older adults.

Transitions from healthcare to self-care: a qualitative study of falls service practitioners' views on self-management.

PURPOSE: The aim of this study was to understand the views of falls service practitioners regarding: their role in supporting self-management of falls prevention; and a transition pathway from National Health Service (NHS) exercise-based falls interventions to community-run exercise programmes. METHOD: Semi-structured interviews were conducted with physiotherapists, nurses, and rehabilitation assistants (n = 8) who worked in an NHS falls service. Data were analysed using thematic analysis. RESULTS: Certain aspects of supporting patients in self-management were deemed to be within or beyond the scope of falls service practitioners. Challenges in supporting transition to community-run programmes included: practitioner awareness and buy in; patient buy in; and patient suitability/programme availability. CONCLUSION: Practitioners sought to be patient-centred as a means to engage patients in self-management of falls prevention exercises. Time-limited intervention periods and waiting list pressures were barriers to the promotion of long-term self-management approaches. A disconnect between falls service interventions and community-run programmes hindered willing practitioners from supporting patients in transitioning. Unless falls risk and prevention is seen by healthcare providers as a long-term condition which requires person-centred support from practitioners to develop self-management approaches, then falls services may only be able to offer short-term measures which are potentially not long lasting.IMPLICATIONS FOR REHABILITATIONFalls rehabilitation practitioners need to take a person-centred approach to engage patients in self-management of falls prevention exercises.Providing information and signposting to exercise opportunities such as community-run programmes following falls service interventions should be viewed as being within the scope of the role of falls service practitioners.Rehabilitation practitioners should consider viewing falls risk as a long-term condition, to promote longer-term behavioural change approaches to ongoing engagement of exercise for falls prevention.

Physiotherapists' views on their role in self-management approaches: A qualitative systematic review.

BACKGROUND: Self-management has been an increasingly important aspect of helping people manage their long-term conditions. The aim of this qualitative review was to synthesize the views of physiotherapists concerning their delivery of a self-management approach. METHOD: A systematic search was conducted on six electronic bibliographic databases to identify relevant primary studies. Studies were assessed for quality and data extracted. Qualitative data were analyzed using thematic synthesis. A total of 1189 studies were identified and screened. Eleven studies met the inclusion criteria. RESULTS: Findings suggest that for self-management approaches to work, physio-therapists believe that patients need to actively participate. Boundaries on who is the expert were blurred at times with some physiotherapists struggling to relinquish control. High-quality patient-therapist relationships are required to build trust in order to support patients in the self-management of their long-term conditions. It is also important to consider the competing paradigms in which a service is delivered as this may facilitate or hinder self-management. Seeing patients as people is integral to supporting self-management approaches. CONCLUSION: Physiotherapists are well placed to support self-management but there is still a need for a cultural and paradigmatic shift in the physiotherapy profession and in some environments, this shift as yet is to be realized.

Na(+)-induced inward rectification in the two-pore domain K(+) channel, TASK-2.

TASK-2 is a member of the two-pore domain K(+) (K(2P)) channel family that is expressed at high levels in several epithelia, including the proximal tubule. In common with the other TASK channels, TASK-2 is sensitive to changes in extracellular pH. We have expressed human TASK-2 in Chinese hamster ovary cells and studied whole cell and single-channel activity by patch clamp. The open probability of K(2P) channels is generally independent of voltage, yielding linear current-voltage (I-V) curves. Despite these properties, we found that these channels showed distinct inward rectification immediately on the establishment of whole cell clamp, which became progressively less pronounced with time. This rectification was due to intracellular Na(+) but was unaffected by polyamines or Mg(2+) (agents that cause rectification in Kir channels). Rectification was concentration- and voltage-dependent and could be reversibly induced by switching between Na(+)-rich and Na(+)-free bath solutions. In excised inside-out patches, Na(+) reduced the amplitude of single-channel currents, indicative of rapid block and unblock of the pore. Mutations in the selectivity filter abolished Na(+)-induced rectification, suggesting that Na(+) binds within the selectivity filter in wild-type channels. This sensitivity to intracellular Na(+) may be an additional potential regulatory mechanism of TASK-2 channels.