Primary Health Care Research & Development 

About: Primary Health Care Research & Development is an academic journal published by Cambridge University Press. The journal publishes majorly in the area(s): Health care & Medicine. It has an ISSN identifier of 1463-4236. It is also open access. Over the lifetime, 1274 publications have been published receiving 13789 citations. The journal is also known as: Primary health care research and development.

Parenting self-efficacy, parenting stress and child behaviour before and after a parenting programme.

Abstract: Aim: To explore whether changes in parenting self-efficacy after attending a parenting programme are related to changes in parenting stress and child behaviour. Background: Adverse parenting is a risk factor in the development of a range of health and behavioural problems in childhood and is predictive of poor adult outcomes. Strategies for supporting parents are recognised as an effective way to improve the health, well-being and development of children. Parenting is influenced by many factors including the behaviour and characteristics of the child, the health and psychological well-being of the parent and the contextual influences of stress and support. Parenting difficulties are a major source of stress for parents, and parenting self-efficacy has been shown to be an important buffer against parenting stress. Methods: In all, 63 parents who had a child under the age of 10 years took part in the research. Of those, 58 returned completed measures of parenting self-efficacy, parenting stress and child behaviour at the start of a parenting programme and 37 at three-month followup. Findings: Improvements in parenting self-efficacy and parenting stress were found at follow-up, but there was less evidence for improvements in child behaviour. The findings clearly suggest a relationship between parenting self-efficacy and parenting stress; parents who are feeling less efficacious experience higher levels of stress, whereas greater parenting self-efficacy is related to less stress. This study adds to the evidence that parent outcomes may be a more reliable measure of programme effectiveness than child outcomes at least in the short term.

Air pollution and your brain: what do you need to know right now.

Abstract: Research links air pollution mostly to respiratory and cardiovascular disease. The effects of air pollution on the central nervous system (CNS) are not broadly recognized. Urban outdoor pollution is a global public health problem particularly severe in megacities and in underdeveloped countries, but large and small cities in the United States and the United Kingom are not spared. Fine and ultrafine particulate matter (UFPM) defined by aerodynamic diameter (<2.5-μm fine particles, PM2.5, and <100-nm UFPM) pose a special interest for the brain effects given the capability of very small particles to reach the brain. In adults, ambient pollution is associated to stroke and depression, whereas the emerging picture in children show significant systemic inflammation, immunodysregulation at systemic, intratechal and brain levels, neuroinflammation and brain oxidative stress, along with the main hallmarks of Alzheimer and Parkinson's diseases: hyperphosphorilated tau, amyloid plaques and misfolded α-synuclein. Animal models exposed to particulate matter components show markers of both neuroinflammation and neurodegeneration. Epidemiological, cognitive, behavioral and mechanistic studies into the association between air pollution exposures and the development of CNS damage particularly in children are of pressing importance for public health and quality of life. Primary health providers have to include a complete prenatal and postnatal environmental and occupational history to indoor and outdoor toxic hazards and measures should be taken to prevent or reduce further exposures.

Diet and physical activity in the self-management of type 2 diabetes: barriers and facilitators identified by patients and health professionals.

Abstract: UNLABELLED Aim To explore the views of individuals recently diagnosed with type 2 diabetes in relation to self-management of dietary intake and physical activity, and to compare these with the views of health professionals (HPs). BACKGROUND Diabetes education has become a priority area in primary and secondary care, and many education programmes are now embedded within a patient's care package. There are few contemporaneous explorations of patients' views about lifestyle self-management. Such research is vital in order to identify areas that require further support, refinement or enhancement in terms of patient education. METHODS Focus groups were held with patients recently diagnosed with type 2 diabetes (n = 16, 38% female, aged 45-73 years). In-depth semi-structured interviews were conducted with HPs (n = 7). Discussions focussed on self-management specifically in relation to making dietary and physical activity changes. All discussions were tape recorded, transcribed and analysed by emergent themes analysis using NVivo to manage the coded data. Findings Barriers were divided into six main categories: difficulty changing well-established habits, negative perception of the 'new' or recommended regimen, barriers relating to social circumstances, lack of knowledge and understanding, lack of motivation and barriers relating to the practicalities of making lifestyle changes. HPs generally echoed the views of patients. In conclusion, even against a background of diabetes education, recently diagnosed patients with type 2 diabetes discussed a wide range of barriers to self-management of diet and physical activity. The findings could help to provide HPs with a deeper understanding of the needs of recently diagnosed patients and may help refine current diabetes education activities and inform the development of educational resources.

Can social prescribing provide the missing link

Abstract: Background: The voluntary sector has long been recognised as making an important contribution to individual and community health. In the UK, however, the links between primary health care services and the voluntary and community sector are often underdeveloped. Social prescribing is an innovative approach, which aims to promote the use of the voluntary sector within primary health care. Social prescribing involves the creation of referral pathways that allow primary health care patients with non-clinical needs to be directed to local voluntary services and community groups. Such schemes typically use community development workers with local knowledge who are linked to primary health care settings. Social prescribing therefore has the potential to assist individual patients presenting with social needs to access health resources and social support outside of the National Health Service. Aim: The aim of this paper is to explore the concept of social prescribing and discuss its value as a public health initiative embedded within general practice. Methods: The rationale for social prescribing and existing evidence are briefly reviewed. The paper draws on a case study of a pilot social prescribing scheme based in general practice. Data collected during the development, implementation and evaluation of the scheme are used to illustrate the opportunities and limitations for development in UK primary health care. Findings: The potential for social prescribing to provide a mediating mechanism between different sectors and address social need is discussed. The paper argues that social prescribing can successfully extend the boundaries of traditional general practice through bridging the gap between primary health care and the voluntary sector. The potential for wider health gain is critically examined. The paper concludes that social prescribing not only provides a means to alternative support but also acts as a mechanism to strengthen community–professional partnerships. More research is needed on the benefits to patients and professionals.

Challenges to primary care from co- and multi-morbidity.

Abstract: Medical education is based largely on the challenges of providing high-quality care for specific diseases. Most learning in medical school is carried out by teacher-researchers with expertise in one particular disease or, at best, teachers with special knowledge in one type of disease or an intervention to treat or manage one type of health problem, leading to health care in many countries being led by specialist rather than generalist medicine. Increased effectiveness of health services’ interventions that delay death by managing (although not necessarily curing) diseases has led to a marked increase in the coexistence of separate diseases in individual people. Older literature expressed this notion by the term ‘co-morbidity’: the co-occurrence of unrelated diseases. Total morbidity is not the same as the sum of different diseases – despite the fact that virtually all population data on diseases assumes that it is. The sum of deaths attributed to individual diseases in the world is greater than the total number of deaths (Murray et al., 2004). Neither morbidity nor multi-morbidity is randomly distributed in populations. People and populations differ in their overall vulnerability to illness and resistance to threats to their health; some have more than their share of illness and some have less. Clustering of diseases is a result of a complex pattern of interacting influences, extending far beyond biological vulnerability. It is more common in socially deprived populations and more common in children as compared with its expected frequency based on frequency of individual diseases in populations (despite lower frequencies of morbidity). This morbidity mix (sometimes called ‘case-mix’ by health services managers) is often called multi-morbidity. When considered in the context of demands on health services, it is known as ‘morbidity burden’. Over time, and particularly in the last decade or two, the frequency of diagnosed morbidity has increased, at least partly as a result of lowered thresholds for diagnosis, inclusion of new diagnoses (including some risk factors, such as obesity) and perhaps also as a result of true increases in some diseases (such as those resulting from environmental insults over time). As a result of these changes, the frequency of multi-morbidity is increasing. It is not necessarily the case that increased multi-morbidity would be associated with increased morbidity burden. For example, among the elderly in the United States, the percentage of people with five or more diagnosed conditions who reported being in excellent or good health increased from 10% to 30% between 1987 and 2002 (Thorpe and Howard, 2006). Thus, morbidity has decreased (by self-reports), but physicians are generating more interventions for the diagnosed conditions and, hence, greater burden on the health system. Increases in multi-morbidity are associated with great increases in costs of care, hospitalizations that should be preventable, and adverse events (Wolff et al., 2002). Because it is also associated with increased likelihood of referrals (Forrest et al., 2006), it has great impact on the balance of use of services between primary care and specialist physicians. Although disease-oriented specialists tend to see people with LESS severe disease (Hartz and James, 2006), they dominate the care of people with high burdens of morbidity because of the multiplicity of disease types and, therefore, different types of specialists; this is especially the case in the elderly, at least in the United States (Starfield et al., 2003). Because excessive use of specialist care is unnecessary, potentially dangerous, and very costly (Starfield et al., 2005), consideration of their appropriate use is warranted. Use of specialist services varies widely from place to place, even after controlling for degree of morbidity; in the United Kingdom, it is approximately one-third of that among insured people in health plans in the United States (Forrest et al., 2002). Although much higher than in the United Kingdom, it is lower in both Canada and Spain than in the United States. This is the case both for total number of specialist visits as well as proportion of the population with at least one specialist visit in any given year. Controlled for degree of multi-morbidity, the more different