Background Non-communicable diseases [NCDs] are the major cause of mortality globally and are increasing in prevalence. Different healthcare professionals’ access different population groups; and engaging allied healthcare professionals in risk-driven early case detection of certain NCDs may be beneficial, especially those who have not been tested for NCDs within the previous 12 months. The objectives of this study were to determine: whether NCD case finding in dental/community pharmacy settings is feasible in terms of patient acceptability, barriers to recruitment, impact on the existing service. Determine time taken to test for: type 2 diabetes risk [T2DM], chronic obstructive pulmonary disease [COPD], hypertension, vitamin D deficiency and chronic kidney disease [CKD]. Determine whether there is added benefit of point of care testing [POCT] to identify diabetes risk compared to a validated screening questionnaire alone. Methods An exploratory study was undertaken to explore issues associated with NCD assessment in one dental practice and one community pharmacy within the West-Midlands, UK. Fifty patients > 40 years-of-age were recruited per site. Participants undertook: a questionnaire providing demographic data, any previous NCD diagnosis or positive family history. Validated questionnaires for determining NCD risk [T2DM/COPD]. Chair-side capillary blood [finger-prick] samples for HbA1C, creatinine/eGFR, Vitamin-D. Prior work had been undertaken to measure the agreement between point of care testing [POCT] devices and a central laboratory method, and to gauge the opinions of participants regarding discomfort experienced using venous (antecubital fossa) and capillary (finger-prick) blood collection, via a 10 cm Visual-Analogue-Scale. The POCT devices demonstrated good concordance with laboratory testing and were acceptable methods of blood collection for participants. Results Recruitment rates demonstrated that 8 days were needed to recruit 50 participants and 60% of those approached opted to participate. The principal barrier to participation was time, with average time taken to test being 19mins. Utilising dental and pharmacy settings identified potential cases of previously undiagnosed disease. Conclusions Risk-targeted testing for NCDs in high street dental and community pharmacies is both attractive and acceptable to patients.
heumatic heart disease (RHD) is prevalent among young people in many sites of social disadvantage globally, with one location being Aboriginal towns and communities in northern Australia. RHD is a complex condition requiring good health communication to enable families to build effective health literacy for their situation. 1 Schools are a logical entry point for health communication about acute rheumatic fever (ARF) and RHD because the population most at risk of ARF -the precursor to RHD -is school-aged children. 2,3 Yet just how to approach health communication and what methods are most effective remain unclear. 4 For Aboriginal families, explanations about RHD are often provided in English by healthcare providers with high levels of western education and health training structured around biomedical ways of thinking. Uncritical use of the biomedical lens when teaching about RHD, even if simplified, can impede health communication so that messages are not understood by Aboriginal people as intended. 5 This is especially so where there is significant language and cultural difference between healthcare providers and clientele. 6,7 In the context of post-colonisation, disempowering health communication may deepen a sense of subjugation or invoke passivity. 8 Empowering pedagogies are urgently needed for RHD because it significantly impacts school-aged children's quality of life and life expectancy, while being largely preventable. 9
An amendment to this paper has been published and can be accessed via the original article.
Circle of Friends (CoF) was originally developed in Canada as a social tool for including vulnerable children and adults within their mainstream schools or communities (Pearpoint et al., 1992). It has subsequently been adopted by schools in the UK as a strategy for including pupils, with a range of challenging needs or behaviours, who have become rejected by or isolated from their peers.This paper examines the contribution of CoF towards achieving positive outcomes for socially isolated children in schools. It reviews evidence from current qualitative and quantitative studies and a Grounded Theory (GT) research study undertaken by the lead author. The design involved interviews with 25 facilitators of CoF within mainstream schools in a large Shire County and an outer London suburb. The children comprising the CoF groups ranged in age from 7 to 12 years.The psycho-social processes emerging from the analysis provide theoretical insights into the part played by the Circle group in providing social feedback and support for the focus child and promoting more positive relationships with the wider class group.At its highest level of conceptualisation the final theory describes how a CoF is perceived to facilitate the movement of a pupil from a ‘closed’ or isolated, social field towards more ‘open’, peer based networks of social support.Implications for future research are discussed. It is argued that complex humanist interventions need to be evaluated and developed using ecologically sensitive methods.
BackgroundThe UK Medicines Health products Regulation Agency instructs that valproate prescriptions should be restricted in women of childbearing age to those consenting to the Pregnancy Prevention Programme (PPP). We assessed the compliance and barriers to the valproate PPP.MethodsWe retrospectively audited NHS Grampian’s compliance with PPP guidelines among women of childbearing potential prescribed valproate between October 2017 and March 2018. Additionally, we prospectively reviewed new valproate prescriptions from February 2019 to March 2022 and compared this with our retrospective data to assess the effectiveness of our identification process using descriptive statistics.ResultsWe identified 351 women retrospectively and 80 women prospectively. Epilepsy, migraine and psychiatry were the main indications. There was a decline in valproate use over the years, particularly for epilepsy. Initially, only 132 (37.6%) met the PPP requirement, and eventually, 81 (23%) stopped the medication. Despite efforts, 38 (10.8%) had contact with secondary care but still did not meet PPP and 100 (28.5%) had no documentation or referral to secondary care. Patients not meeting PPP lacked capacity, most commonly with severe learning difficulties. Women treated for psychiatric purposes were less likely to meet PPP than other indications.ConclusionsA significant proportion of women continue valproate treatment without meeting the PPP requirement. This is linked to their indication for prescription and their comorbidities. Collaborative input from relevant specialities and primary care is required to fully achieve PPP if a national valproate database is to be established.
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