An outdated physical education syllabus is failing the fitness of our school children according to Olympic and physical education expert Sheila Wigmore from Sheffield Hallam University. She also highlights the importance of the 2012 Olympics in helping shine a positive light on the UK following the involvement in the Middle East crisis.

A member of several British Olympic groups and sport lecturer at Sheffield Hallam University, Sheila Wigmore claims ‘the demise of home economics, combined with the onset of fast food and computer game culture and being confined to the house by parents concerned with the perceived lack of safety on the street’ have added to young obesity issues. However she also believes school physical education, which is comparable to the 1933 curriculum, doesn’t engage children with ‘far too much emphasis on competitive games.’

She said: “We have got to move away from the health aspect and start promoting the social. Children are becoming adults much younger and are worried about their hair, nails and getting sweaty - telling an 11 year old that sport will make them healthier at fifty doesn’t register. However showing that activity can help them make friends and be happy in a range of environments will help them enjoy moving their bodies again, whilst coincidentally improving their health. Local Authorities and sporting clubs need to work with schools for this to happen.”

Sheila began her love affair with the Olympics in 1989 after a conference paper given by Doctor Don Anthony captivated her with anecdotes of its unique history and future possibilities. The sporting ambassador then became involved with the British Olympic Association and the National Olympic Academy. She is now part of a team at Sheffield Hallam spearheading the Lighting the Flame campaign that embodies the city’s ongoing commitment to the Olympics, ensuring the region’s sporting offer en route to 2012 is promoted.

“I’m angered by the negative media around the London 2012 Olympics. It is a very important occasion for the UK. The Olympics has brought together nations since 1896. Olympism is still strong promoting friendship, tolerance and understanding. We are showcasing the nation across the world, and particularly given our current involvement in the Middle East, this has got to be good opportunity to show other facets of our nation.

“If you speak to any sports person, being the Olympic champion is more important to them than being a world champion. Despite not being paid during the Games, the sponsorship and media coverage afterward can make them millions of pounds. But in addition to this, sports tourism brings money into the country and individual cities, and our very British ‘it’s never going to work’ and ‘will cost too much’ attitude has got to end!”

Sheffield Hallam plays an active role in supporting the growth and development of budding young Olympians. The University’s elite athlete programs support sporting champions such as Olympic silver medal diver Leon Taylor, Commonwealth Games triathlete Damian Thacker and bronze European Athletics Championships winner Sam Ellis to complete studies between training.

Sheila’s academic work focuses on the philosophy of physical education, sport ethics and the sociology of sport and physical education, and is an active member of the Association for Physical Education that supports physical education in schools and community.

“Given that Sheffield is the first City of Sport I think it’s shocking our region is one of the most inactive [according to the latest research by Sport England]. We need to become a city of exercise and activity. There was so much reorganising and funding put towards the World Student Games that local facilities fell into disrepair. I appreciate there are more complex issues going on and without the games Sheffield wouldn’t have regenerated through sport tourism, but there should be more money in the pot to distribute to local exercise and sport facilities - and this isn’t just a problem for Sheffield!”

Sheila will discuss how physical education can contribute to creating active people for life and establishing appreciative spectators and volunteers for the 2012 Olympics during a public lecture at Sheffield Hallam University on 17 January, 2007. Tickets for the event are free but should be booked in advance through events@shu.ac.uk or 0114 225 4957.

http://www.shu.ac.uk

McMaster University pediatric cancer specialist Dr. Ronald Barr says the teen gap in cancer care has been overlooked for far too long.

Statistics show that gains in survival rates for teenagers and young adults (age 15 - 29) with cancer are dismal when compared to those for youngsters and older adults with the disease.

“While there have been improvements in survival in children and older adults in recent decades there has been no such improvement in this age group in the past 25 years or so,” said Barr, a professor of pediatrics of the Michael G. DeGroote School of Medicine at McMaster University and chief of hematology-oncology at McMaster Children’s Hospital.

Barr, who is involved in local, national and international efforts to reverse this trend, is available for interviews to discuss this issue.

Barr is one of the editors of the recently released and first definitive document on the incidence, survival and mortality of 15 - 29 year-olds. Funded by the National Cancer Institute (NCI) in the United States, this monograph was a co-operative venture between the Children’s Oncology Group (all 17 pediatric oncology centers in Canada and more than 200 American institutions) and the SEER (Survival Epidemiology and End Results) program.

Barr is a member of the NCI and Lance Armstrong Foundation’s new Progress Review Group whose sole purpose is identifying and prioritizing the scientific, medical and psychosocial barriers facing adolescent and young adult (AYA) cancer patients. They plan to develop strategies to better the odds for this age group.

“The Lance Armstrong Foundation is very keen to advocate for young people with cancer and educate them in high schools, colleges and work places to the fact cancer can afflict people in their age group - and that when they get a lump they shouldn’t say ‘it’s just a lump’ but that it might be a form of cancer,” Barr said.

Barr co-chairs the Working Group on AYA within the International Society for Pediatric Oncology which will soon publish proceedings from its first workshop on AYA adolescent and young adults with cancer. He is also one of the authors and editors of an upcoming book on this issue.

He said there are a variety of reasons why the outlook is so poor for this particular age group. Chief among them is the fact so few are participating in clinical trials - organized studies which test the value of various treatments, such as drugs or surgery in human beings. This lack of involvement correlates directly with their poor survival rates, he said.

Young people’s feelings of invincibility, coupled with a lack of awareness about their cancer risk, are other factors. And often family physicians aren’t suspicious enough of teenagers’ symptoms, interpreting a lump in the neck as an infection or leg pain as an athletic injury or growing pains, which delays an accurate diagnosis.

Even more confusing, Barr said, is the fact that the types of cancer within the 15 - 29 age group occur at different frequencies across this age range, the most common types in teenagers being different from the most common types in young adults.

http://www.mcmaster.ca

As national spending on prescription drugs rose faster than any other segment of health care spending, the health plan at Wake Forest University Baptist Medical Center was able to maintain constant spending, resulting in savings of more than $6.6 million over three years.

Four health plan interventions not only averted increases in prescription drug spending but also preserved members’ use of medications for chronic conditions, according to a manuscript published today (Aug. 7) in The American Journal of Managed Care.

“Other studies have found that single cost-control strategies such as increasing co-payments can decrease prescription drug spending,” said lead author David P. Miller, M.D., assistant professor in the Section of General Internal Medicine at Wake Forest University School of Medicine. “However, we present the results of a combination of strategies used in concert.”

The manuscript describes a three-year observational study conducted at the Medical Center, comprised of Wake Forest University Health Sciences and North Carolina Baptist Hospital. The institution, with more than 11,000 employees, ranks among the top 15 largest employers in North Carolina. Employees of both organizations are members of the health plan.

“One reason for this success may be that the plan was careful to avoid shifting costs to its members,” said Miller. “Whenever a drug was changed to a more expensive tier or removed from the formulary, the members’ out-of-pocket costs were the same or less if they changed to the less-expensive alternative.”

The interventions included reclassifying select brand-name drugs to non-preferred status (resulting in approximately half of the annual savings), followed by (in descending order of savings) the removal of non-sedating antihistamines from the prescription-drug formulary, the introduction of pill-splitting, and the limitation of quantities of select medications not intended for daily use.

The health plan’s goal, according to the study’s authors, was to control prescription drug spending while preserving high quality medical care. An advisory outpatient prescription drug committee, which included physicians and pharmacists, was formed to review the literature and ensure that proposed strategies wouldn’t have a negative impact on health care quality.

According to co-author Curt D. Furberg, M.D., Ph.D., professor of public health sciences, “The study demonstrated that much of what we spend on prescription drugs is wasteful, and that other institutions, hospitals, health plans, state and federal governments can learn from our experience.”

The study’s authors wrote that preventing the rise of prescription drug costs allowed the health plan to invest in new initiatives to improve the health outcomes of patients with chronic disease, such as reducing the co-payments for insulin and diabetic testing supplies to encourage medication adherence and monitoring.

Another co-author, Ronald H. Small, M.B.A., vice president for quality outcomes, noted that the collaboration between physicians and the hospital worked well to ensure not only that cost savings could be achieved but also that employees received pharmaceuticals that are shown by evidence to be effective.

Besides Miller, Furberg, and Small, the authors of the study include Franklyn M. Millman, M.D., Walter T. Ambrosius, Ph.D., Julia S. Harshbarger, PharmD, and Christopher A. Ohl, M.D., all with Wake Forest.

Wake Forest University Baptist Medical Center is an academic health system comprised of North Carolina Baptist Hospital and Wake Forest University Health Sciences, which operates the university’s School of Medicine. The system comprises 1,154 acute care, psychiatric, rehabilitation and long-term care beds and is consistently ranked as one of “America’s Best Hospitals” by U.S. News & World Report .

http://www.wfubmc.edu/

On Wednesday, the U.S. House of Representatives passed the “Children’s Health and Medicare Protection Act of 2007 (CHAMP)” (H.R.3162), which expands health care coverage to pregnant women and their children and addresses a long-standing inequity in reimbursement for services of certified nurse-midwives (CNMs). The American College of Nurse-Midwives (ACNM) is proud to have endorsed this important legislation and worked hard for its passage.

“H.R.3162 can have a profound impact on health coverage for children and improve women’s access to midwifery services under the Medicare program,” stated ACNM President Eunice K. M. “Kitty” Ernst, CNM, MPH, DSc(Hon), FACNM. The legislation would ensure that many of our nation’s uninsured children have access to vital health care coverage through the State Children’s Health Insurance Program (SCHIP). It will also improve access to care for children in underserved areas, help reduce minority health disparities, and protect the Medicare program for the long term.

ACNM especially applauds the provision in the bill eliminating payment limits for CNM services under Medicare dating back to 1988. CNMs are limited to receiving 65% of the Medicare fee, and many Medicaid and private health plans follow Medicare fee schedules, further reducing access to care for vulnerable populations. Under H.R.3126, as of April 1, 2008, CNMs would join the ranks of other health professionals already receiving 100% reimbursement for their services under Medicare, including all physicians (including chiropractors, optometrists, and podiatrists), nurse-anesthetists, audiologists, speech language pathologists, physical therapists, and occupational therapists.

“Expanded access to midwifery care in other countries has produced better outcomes at lower cost and is supported in this country by 80 years of outcomes research on midwifery care,” Ernst noted. “Reports and recommendations from both the public and private sector also point to the important role that midwives can play in reducing infant mortality, unnecessary cesarean sections, and routine medical interventions in the normal process of childbirth.”

ACNM also supports provisions within the SCHIP portion of the bill that will allow states to apply outreach procedures and programs to all children and pregnant women and provide states the option to expand and add coverage of pregnant women under SCHIP.

“ACNM congratulates the House of Representatives on this tremendous achievement, and celebrates the passionate advocacy of midwives who helped achieve this important victory,” said Ernst. “It’s critically important that we maintain this momentum to ensure strong support in the Senate for this provision so that it is finally enacted into law,” she urged.

http://www.midwife.org

Council 31 of the American Federation of State, County and Municipal Employees (AFSCME) issued a new report documenting low wage levels that keep patient support staff at Resurrection Health Care hospitals mired in poverty and unable to support their families.

Resurrection Health Care (RHC) is the second largest non- profit hospital system in the Chicago metropolitan area. It encompasses eight hospitals, as well as nursing homes, home health services, and outpatient clinics.

Entitled Coming Up Short: Resurrection Health Care’s Distorted Pay Priorities, the report depicts a starkly skewed pay structure in which the compensation of RHC hospital executives significantly exceeds national norms while the meager wages of patient-support staff (housekeepers, laundry and food service workers) fall far short of self-sufficiency standards in the Chicago area.

The new report was sparked by an employee petition drive pressing for wage increases for patient-support staff which Resurrection management sought to stifle. The National Labor Relations Board Regional Office has recently indicated that it will issue a formal complaint against Resurrection for allegedly violating federal labor laws by interrogating an employee who was circulating the petition and interfering with her rights.

The report also documents tens of millions of dollars spent on cosmetic remodeling projects at Resurrection hospitals that could be used to help raise patient-support workers out of poverty.

Findings from the report include the following:

• Resurrection’s lowest-paid employees earn only $9 an hour, well below the federal poverty line for a family of four. Resurrection also caps wages for its patient-support staff with a “maximum rate” that prevents even loyal, long-term employees from reaching an income level that would allow a family to achieve economic self-sufficiency.
• The employee premium contribution for Resurrection’s family health care coverage averages more than $230 per month, more than one-sixth the monthly take home pay of low-wage Resurrection workers. Copays and deductibles add greater costs for workers.
• In 2006, Resurrection Health Care CEO Joseph Toomey’s total compensation was more than $1 million. Toomey took in more in just three hours than RHC’s lowest-paid employees takes home in an entire month.
• Compensation for the top executive at each Resurrection hospital exceeded national medians for similar-sized hospitals in 2006 by 14% to 94%.
• RHC’s top tier of management (90 individuals) earned a combined total of more than $26 million last year. If this amount were reduced by just 5%, all patient support staff could be paid an additional $105 per month.
• Of the $24 million dollars allocated for expansion of West Suburban Medical Center’s emergency room, 54% is directed toward non-clinical improvements that will not directly benefit the quality of patient care.

“The low wages paid to these Resurrection workers are shameful, particularly when contrasted with the lavish salaries the company’s top executives pay themselves,” said Roberta Lynch, deputy director of AFSCME Council 31. “These are the workers who mop the floors, change the bedpans, and launder the sheets and Resurrection would simply grind to a halt without them. Yet some of these workers cannot even afford medical care at the very hospital at which they work.”

“The best way to ensure fair pay is for Resurrection employees to be able to form their union,” said Linda Chavez-Thompson, executive vice-president of the AFL-CIO who joined AFSCME in releasing the report. “It’s time for Resurrection management to honor the people whose hard work allows the hospitals to operate, and respect the workers’ rights to organize a union.”

“After more than ten years working in the laundry at Resurrection Medical Center, I earn only $9.60 per hour,” said Araceli Romero. “Work in the laundry is very difficult. We stand all day untangling wet, heavy linens and throwing them into large bins. Many of my co-workers have had serious injuries to their shoulders, backs and wrists.

“While Resurrection brings in billions in revenue, many patient support employees can’t make ends meet and we have to make horrible choices. I have one co-worker who had cancer, and sometimes she skips doctor checkups because she can’t afford the co-pays,” she said.

“These low wages are an embarrassment for a Catholic institution,” added Father Larry Dowling, pastor of St. Agatha Church and a member of the Association of Chicago Priests. “Catholic Social Teaching is very clear about the need for employers to pay a living wage and to respect workers’ rights to organize a union. As one of the largest Catholic employers in Chicago, Resurrection needs to lead by example.”

Seeking to improve their working conditions and enhance the quality of patient care, Resurrection employees are working to form a union with AFSCME Council 31.

http://www.reformresurrection.org.

The National Inquiry into Management and Medicine looked at hospitals across the UK, focussing on the often troubled relationships between doctors and NHS managers.

It found that where the two sides have formed a genuine alliance, the health service runs more efficiently, and patient outcomes are improved.

Frictions between doctors and managers have been well documented. And the new research, led by Professor Ian Kirkpatrick of the Leeds University Business School, blames poor relationships between the two sides for the fact that increased productivity in hospitals has not kept pace with the rise in spending.

“It can be difficult for doctors and managers to get on,” said Becky Malby, Director of the University’s Centre for Innovation in Health Management, which published the research. “But our study shows that where the two sides work together, everyone can benefit.”

And now the centre hopes to use the good examples set by some hospitals to improve relationships in the others.

“There has been a tendency to think that these problems can be changed simply by changing management structures,” said Becky. “You find people fiddling about with structures when in fact it’s more important to get the actual relationships right.

“Managers and doctors are always going to have different points of view about the way the NHS should be run. But the places which succeed are those where they have transcended this and where they see these different points of view as a strength.”

Becky points to power struggles within the NHS as a source of difficulties: “Over the past 20 years, general managers began to develop a power base to rival that of the doctors,” she said. The report says the first step in developing productive relationships is for the two sides to be willing to work together , and to take a genuine interest in each other’s work and pool their resources.

“The business of the NHS should be health, not just managing the money,” said Becky. “The questions they should ask are: “Are we doing the best for our patients? and how could we do it better?”

“In the best places, the chief executives are genuinely interested in the patients. And we know that where there’s a good relationship, clinical outcomes for patients are better.”

Now the team plans to bring managers and health professionals together to encourage the best-performing hospitals to spread their good practice to the others. The first step will be a workshop in September which will put forward good examples, using ,buddying and mentoring schemes to pair hospitals with others who would benefit from their advice. These long-term relationships will spread the message that co-operation is key to making the NHS do the best possible job for its patients.

“Both parties will get something out of it,” said Becky. “We want them each to ask, Can we find a hospital which is doing something better than us - or support one that isn’t? And of course if it’s done on a peer-to-peer basis people are going to be much more receptive.”

The National Inquiry into Management and Medicine states: “The NHS is obsessed with money not with clinical care. This report shows that NHS organisations need to focus first and foremost on patients and their treatment and care and that should be modelled at the top of the NHS. General Management cannot “Manage” without knowing the business it is in.” It says the answer is not in structures but in a re-focusing of the organisation’s energy and ways of working: “This means learning what it is like to be a manager if you are a doctor, and what it is like to be a doctor if you are manager.”

Among its recommendations are:

• The NHS should set the direction and expectations for the service, but allow individual trusts to develop their own metrics.
• Chief Executives should stop moving from trust to trust , and where they do move, should ensure a succession plan is in place to conserve productive relationships rather than destroy them.
• Commissioners and providers should be locally accountable.
• Clinicians and management should be involved in the development of performance data.
• Both sides should talk to staff, listen to their experiences of working together, and assess whether their real-life stories suggest the working relationship is productive , or obstructive.
• Medical students should be taught about management earlier in their education, with the curriculum embedding the notion that management is core business for doctors.

http://www.leeds.ac.uk

Union negotiators have secured a new pay offer for health workers.

UNISON will now ask all members working in the NHS whether they wish to accept the offer.

The health executive believes it is the best that can be achieved through negotiation.

Should members reject the new deal, they should also be prepared to support industrial action, the executive said.

The improved offer will put extra cash in the pockets of the lowest paid workers in the NHS, no matter which country they are in. In England only, training budgets for non-clinical staff will be boosted, and clinicians will get money to put towards their registration fees.

Should staff accept the offer, those in Northern Ireland, Scotland and Wales will get the full 2.5% increase recommended by the pay review body immediately, backdated to 1 April this year.

The award will still be staged in England, with staff getting 1.5% payable from 1 April and the remaining 1% from 1 November.

The improved offer at a glance:

• more money for the lowest paid. From 1 November there will be a £400 flat rate increase for those on Bands 1 and 2. Those on Bands 3 and 4 will receive an additional £38 as well as the 2.5%. This will be payable in all 4 UK countries;
• in England only, there will be additional money for staff training targeted directly at those non-clinical staff who often lose out when training budgets are cut;
• also in England only, there will be £38 paid to staff on Bands 5, 6, 7 and 8(a) who are required to register to practice - this money is a contribution to their professional fees.

Full details will be available on the health pages of the UNISON website. They will also be circulated to health branches, and sent to all UNISON members in the NHS, together with ballot papers.

Ballot papers are due to be sent out on 20 August. The ballot will close on 13 September.

http://www.unison.org.uk/rss/

Heart attack patients received lifesaving treatment quickly when hospitals and communities used an integrated, rapid transfer system to get patients to a facility equipped to perform artery-opening procedures, according to a report in Circulation: Journal of the American Heart Association.

“Our aim was to develop a standardized system of heart attack care, which included timely access to artery-opening treatment for patents presenting to either the major hospital with a cardiac catheterization lab or to any one of 30 community hospitals without a cath lab,” said Timothy D. Henry, M.D., lead author of the report and a cardiologist at Abbott Northwestern Hospital in Minneapolis, Minn. Abbott Northwestern Hospital is a 619-bed hospital with a cardiac catheterization lab equipped to treat heart attack patients with the artery-opening procedure called percutaneous coronary intervention (PCI), also known as angioplasty. A major heart attack is when a complete blockage occurs in a coronary artery. This is called an ST-elevation myocardial infarction (STEMI). Doctors treat STEMI patients with either emergency angioplasty or by injecting a clot-busting drug. The time between hospital arrival and treatment is called door-to-balloon time with angioplasty or door-to-needle time with drugs. A shorter door-to-treatment time with either angioplasty or a clot-busting drug increases a patient’s chance of survival. American Heart Association guidelines recommend a door-to-balloon time within 90 minutes and door-to-needle time within 30 minutes. “Angioplasty is preferred over clot-busting drugs for STEMI patients when it can be performed in a timely manner by experienced clinicians,” Henry said. “However, angioplasty isn’t universally available , less than 25 percent of U.S. hospitals are capable of offering it.” Henry and his colleagues at the Minneapolis Heart Institute , 46 cardiovascular specialists at Abbott Northwestern Hospital , developed a regional system of care to:

• Standardize STEMI care throughout the system, using hospital-specific protocols and orders;
• Improve timely access to PCI with first door-to-balloon time of less than 120 minutes (whether they sought care directly from Abbott Northwestern or from a community hospital up to 210 miles away);
• Establish a network for collecting data for STEMI patients who present to rural and community hospitals;
• Implement STEMI quality improvement measures at each hospital that include immediate feedback to both emergency and primary care physicians;
• Improve cardiovascular outcomes in STEMI patients throughout the system.

The refined system of care included elements that have been successful in other hospital systems in the Unites States and Europe, such as:

• The emergency department physician diagnoses STEMI patients and activates the system (patient transfer, cardiologist and cath lab staff) with a single call;
• A specific transfer plan is in place, although the plan might be different for each site;
• Transfer patients are taken directly to the coronary catheterization laboratory, without re-evaluation in the emergency department;
• A back-up protocol is in place for anticipated delays, such as inclement weather;
• Education is ongoing, including immediate and quarterly training with emergency department staff, paramedics, angioplasty lab staff, primary care physicians, etc.;
• A comprehensive feedback plan is developed to monitor progress and quality assurance.

A unique part of the program was that doctors treated every patient the same. Even higher risk patients, such as the elderly and those with out-of-hospital cardiac arrest and cardiogenic shock, were transferred to the primary angioplasty center. Other programs have often used selection criteria that would exclude the sickest of patients from data collection.

“Despite the high-risk patient population, in-hospital mortality was 4.2 percent and median length of stay was three days,” Henry said.

From March 2003 to Nov. 2006, 1,345 consecutive STEMI patients were treated at Abbott Northwestern, including 1,048 transferred from non-PCI hospitals. Transferred patients were grouped into zones based on how far they traveled to get to Abbott Northwestern. Zone 1 patients came from within 60 miles of the PCI center, and Zone 2 patients came from 60:210 miles away. The median door-to-balloon time for patients in Zone 1 was 95 minutes and 120 minutes for patients in Zone 2. Median travel time was 22 minutes from a Zone 1 hospital and 34 minutes from Zone 2.

“We’ve shown that an integrated transfer system can expand the benefits of primary PCI to communities that are up to 210 miles away,” Henry said. “Remarkably, despite a 30- and 55-minute longer time to treatment for Zone 1 and Zone 2 patients compared with those who arrived directly at the PCI center, there was no difference in in-hospital, 30-day or 1-year mortality.”

“The success of this regional system was one of the reasons the American Heart Association used it as a model for Mission: Lifeline, our initiative to develop STEMI systems of care across the country,” said Alice Jacobs, M.D., past president of the American Heart Association, professor of medicine at Boston University School of Medicine and director of the cardiac catheterization lab at Boston Medical Center. “Empowering communities to improve their systems of care will get patients with heart attacks to the hospital more quickly. Saving time saves lives and that is our ultimate goal.”

http://www.americanheart.org

Three million seniors could lose their Medicare Advantage coverage, while millions more would face benefit cuts and higher out-of-pocket health care costs under legislation passed today by the U.S. House of Representatives.

Noting that 49 percent of Medicare Advantage beneficiaries have incomes of less than $20,000 per year, Karen Ignagni, President and CEO of America’s Health Insurance Plans (AHIP), said the legislation would have a devastating impact on seniors’ health security.

“The House bill shreds the safety net for millions of seniors who depend on Medicare Advantage,” said Ignagni.

In testimony before the Ways and Means Committee last week, Peter Orszag, Director of the non-partisan Congressional Budget Office, said that Medicare Advantage enrollment would fall by 33 percent under the legislation passed today by the House. A study from an independent researcher and former senior health care official in the Clinton Administration, Ken Thorpe, estimates that the proposed cuts would result in 3.2 million seniors losing their Medicare Advantage coverage and that Medicare Advantage would no longer be available to seniors in 22 states. Seniors in these states would have to enroll in the fee- for-service Medicare program, where they would likely receive fewer benefits and pay higher out-of-pocket costs than they do in Medicare Advantage.

AHIP also reiterated its support for strengthening the State Children’s Health Insurance Program (SCHIP), which is a key element of AHIP’s comprehensive proposal to cover the uninsured. AHIP has run advertisements in support of raising tobacco taxes to finance SCHIP and joined with a diverse group of national organizations to promote the program through the Health Coverage Coalition for the Uninsured.

http://www.ahip.org/

Only one in seven UK doctors’ surgeries provide well-developed support programmes for obese patients, according to a survey of primary care nurses published in the latest Journal of Advanced Nursing.

Sheffield-based researchers surveyed just under 400 nurses in the north of England in mid 2006, including district nurses, practice nurses and health visitors.

Their aim was to ask the nurses about their clinical practice, views and support for patients with obesity.

The researchers discovered that 89 per cent of nurses recognise the need for more effective primary care services to tackle obesity and see obesity advice and support as part of their role.

However, one in five nurses also admitted that they felt awkward or embarrassed about talking to patients about obesity and only a fifth felt they were effective when it came to helping patients to lose weight.

Half said that they found providing care and support for obese patients particularly rewarding, but some also expressed negative attitudes and beliefs.

It’s estimated that one in five adults in the survey area - which covered four primary care trusts in the north of England - are obese, reflecting national UK trends.

Many of the nurses in the current survey also had weight problems - 14 per cent were obese and 29 per cent were overweight.

“Primary care nurses have an important role when it comes to helping patients to tackle obesity, which can lead to diseases like coronary heart disease and diabetes” says lead researcher Dr Ian Brown from Sheffield Hallam University.

“But they clearly need further training and organisational support to provide the help that obese people need to lose weight, in line with new UK health guidelines.

“Any training programmes should also address nurses’ beliefs and attitudes. While outright negatives stereotypes were rare, a number of nurses displayed potentially negative beliefs and attitudes relating to obesity and obese people. However, they were much less likely to do this if they were obese themselves”

Key findings of the study included:

Clinical practice

• 36 per cent of nurses (mainly practice nurses) carried out weight assessments in a typical week but another 36 said they’d never done one in their current post.
• 55 per cent had provided a patient with detailed advice about weight reducing diets and 30 per cent had done so in the last week, with similar percentages reported for exercise advice.
• 197 patients had been referred in the last four weeks - including 39 per cent to local exercise activities which receive health funding, 27 per cent to a dietician and five per cent to psychological support.

Beliefs

• 88 per cent said the health risks of obesity were not being overstated, but five per cent felt they were.
• 59 per cent said that obesity was the root cause of most of the problems faced by overweight patients.
• 57 per cent felt family history was an important factor in obesity and 28 per cent said hormones were a factor in middle-aged obesity.
• 69 per cent felt obesity was down to personal choices about food and exercise.

Attitudes to obese patients

• 54 per cent of nurses felt empathy for obese patients, but four per cent felt disgust.
• 45 per cent didn’t feel that obese patients had the motivation to change.
• 47 per cent found helping obese patients very rewarding.
• Eight per cent said obese patients were more lazy than non-obese patients.

Obesity management

• 59 per cent felt it was sufficient to give patients advice about weight management, but three per cent said that it wasn’t part of their role.
• 22 per cent felt ineffective when it came to helping patients lose weight, 19 per cent felt awkward about raising the issue and 18 per cent felt embarrassed.
• per cent said obesity was an important service development area.

Organisational support

• Only 17 per cent were aware of a specific clinical protocol at their practice for tackling obesity and only 11 per cent were aware of a lead clinician responsible for obesity management.
• 14 per cent said their practice had a well-developed programme for managing obese patients, but 37 per cent said it didn’t and 49 per cent were unable to answer the question one way or another.

564 nurses across four Primary Care Trusts were surveyed and 398 responded.

96 per cent of the nurses who filled in the questionnaires were female and their average age was 46.

The average body mass index of the respondents, calculated using their height and weight, was 25.5. 43 per cent were obese or overweight. 56 were normal weight and one per cent were underweight.

District nurses made up 44 per cent of the sample, practice nurses 25 per cent and health visitors 22 per cent. The remainder were nursing assistants.

“Obesity is on the rise and it concerns us that front-line staff like primary care nurses are not receiving the training and support they need to help patients tackle the problem” concludes Dr Brown.

“The Government’s advisory body, the National Institute for Health and Clinical Excellence, issued guidelines in December 2006 on how obesity should be managed by UK healthcare professionals, including local family doctors’ surgeries.

“As a result, a number of new policy and service developments are underway, led by the Department of Health.

“However, our findings indicate that considerable development and training will be needed if effective and sensitive programmes are to be put in place.”

http://www.virgin.net/