Staff are interested in developing knowledge and skills pertinent to the psychological problems of their patients and their views reveal a consensus that the most important areas for learning are recognition of mental disorders, anxiety management, crisis intervention and pharmacological treatments for depression.
The relations between size at birth and blood pressure were examined in a population-based longitudinal study of pregnancy and childbirth in the English county of Avon (the Avon Longitudinal Study of Pregnancy and Childhood (ALSPAC)) in 1994-1996. A total of 1,860 singleton children aged 3 years (response rate = 74%) were studied. Both height and body mass index were strongly related to blood pressure. After adjustment for current height and body mass index, birth weight showed a graded inverse relation with both systolic (-1.91 mmHg/kg, 95% CI -2.61 to -1.21 mmHg/kg, p < 0.0001) and diastolic blood pressure (-1.42 mmHg/kg, 95% CI -1.96 to -0.88 mmHg/kg, p < 0.0001) which was similar in boys and girls. Although birth length, head circumference, and ponderal index at birth were also inversely related to blood pressure, these relations disappeared after adjustment for birth weight. The strength of the birth weight-blood pressure relation was not strongly influenced by maternal height or by weight gain in the first year after birth, but was particularly strong in children who were shortest at 3 years of age. While the association between birth weight and blood pressure is consistent with reports from many earlier studies, the absence of independent relations between other measures of size at birth (particularly length:head circumference and ponderal index) and blood pressure does not suggest that undernutrition at a critical period of fetal growth plays an important role. Moreover, accelerated postnatal growth does not seem to underlie the birth weight-blood pressure association.
Training in mental health can lead to increases in confidence and a change in attitudes and would be beneficial for all nurses working in NHS Direct and in other primary care fields. It would also be beneficial to repeat the study with a larger number of nurses and after a longer period of time to assess the long-term effects of training.
There appears to be a need for patients to be better informed about the service they can expect to receive from GP co-operatives. Recent developments such as NHS Direct may have an influence on the telephone consultation rate to GP co-operatives.
Overall, patients were as satisfied with the co-operative as with practice-based or deputizing service arrangements, although many concerns were expressed about the quality of service provision. Differences in satisfaction were greater between forms of service delivery within the co-operative. Dissatisfaction with telephone consultations needs to be considered, together with issues relating to equity in access to out-of-hours' primary care centre consultations and the potential impact of NHS Direct.
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