Background: Despite various guidelines, shortcomings in lifestyle counseling in primary care have been demonstrated. Comparisons between countries may provide insight on how to improve such counseling. To the best of our knowledge, studies comparing patients’ views of lifestyle counseling beween the United States (US) and European countries have not been reported. Objectives: To quantify and compare patients’ perspectives in the US and Sweden on primary care providers’ counseling on weight, eating habits, physical activity, smoking, and alcohol consumption. Methods: In a cross-sectional study, 629 patients from Sweden and the US completed a telephone interview about their experiences after a visit to a physician in primary care. The survey focused on patients’ perception of the importance of healthy lifestyle habits, their need to change, their desire to receive support from primary care, and the support they had actually received. Data were analyzed using chi-square or Fisher’s exact test. Results: For three of the four lifestyle habits, the proportion saying they needed to change was higher in the US. The exception was for alcohol, where Swedish subjects indicated a greater need to change. Among those stating a need to change, the proportion saying that they would like to have support from primary care was generally above 80% in both countries. The proportion of US patients reporting that their primary care provider had initiated a discussion of lifestyle modification was, with the exception of alcohol, roughly double the level reported by the Swedish patients. Conclusions: This study demonstrates high and quite similar patient expectations concerning lifestyle counseling in both countries, but more frequent initiation of discussions of most lifestyle issues in US primary care. Further studies, e.g. qualitative interviews with physicians, and medical record reviews, are required to better understand what can explain the differences between countries indicated by the study.

Mistreatment of student and junior health professionals has been reported internationally. The performing arts have been employed to discuss and address difficult social issues. Turner theorises that research-based verbatim theatre, scripted from interview transcriptions, can explore interrelationships between real-life 'social' drama and performed 'aesthetic' drama.We developed the verbatim theatre play Grace Under Pressure to make experiences of mistreatment in healthcare workplaces apparent to lay and health professional audiences, with the aim of creating vibrant debate. We then explored audience responses to ascertain whether the play enabled them to critically reflect on healthcare culture and potentially facilitate change.Semi-structured interviews with 30 medical students and nurses, paramedics and physicians were transcribed and coded, from which the script was created. Following the performances, medical and nursing students and health professionals discussed their responses to the play at three focus groups. Transcriptions were analysed through theoretical thematic analysis.Themes were: recognition of the play's themes in the healthcare workplace (recognition of personal experience, professionalism, training culture and healthcare workplace culture, and revelations); possible remedies for the healthcare workplace; and critique of the play. Real-life stories and authentic language facilitated recognition of healthcare workplaces by student and practicing health professionals, enabling critical reflection and discussion. We found strong evidence that verbatim theatre can provide an aesthetic frame to consider the voices of those for whom healthcare culture has been unhealthy. This can promote awareness and discussion of the issues, and determination to promote culture change among healthcare professionals, policy makers and the community.

IUCN is a membership Union uniquely composed of both government and civil society organisations. It provides public, private and non-governmental organisations with the knowledge and tools that enable human progress, economic development and nature conservation to take place together.Created in 1948, IUCN is now the world's largest and most diverse environmental network, harnessing the knowledge, resources and reach of more than 1,300 Member organisations and some 16,000 experts. It is a leading provider of conservation data, assessments and analysis. Its broad membership enables IUCN to fill the role of incubator and trusted repository of best practices, tools and international standards.IUCN provides a neutral space in which diverse stakeholders including governments, NGOs, scientists, businesses, local communities, indigenous peoples organisations and others can work together to forge and implement solutions to environmental challenges and achieve sustainable development.Working with many partners and supporters, IUCN implements a large and diverse portfolio of conservation projects worldwide. Combining the latest science with the traditional knowledge of local communities, these projects work to reverse habitat loss, restore ecosystems and improve people's well-being. www.iucn.orgThe Overseas Development Institute (ODI) is the UK's leading independent think tank on international development and humanitarian issues.ODI's mission is to inspire and inform policy and practice which lead to the reduction of poverty, the alleviation of suffering and the achievement of sustainable livelihoods in developing countries. It does this by locking together high quality applied research, practical policy advice, and policy-focused dissemination and debate. It works with partners in the public and private sectors, in both developing and developed countries.ODI has more than 230 staff, including researchers, communicators and specialist support staff who provide highquality research, policy advice, consultancy services and tailored training -bridging the gap between research and policy and using innovative communication to mobilise audiences. www.odi.org @IUCN_Water @IUCN @ODIdevJames Dalton is a member of the IUCN global water team based in IUCN Headquarters in Gland, Switzerland. As an international organisation, IUCN has experience of working with several corporates (e.g. food and nutrition; cement and mining, global energy companies) in collaborative projects. Its motivation in sponsoring and taking part in this study has been the interest in developing a deeper understanding of what motivates businesses to engage, especially in water management beyond the 'factory fence'.Peter newborne is Research Associate to the ODI water policy programme which carries out applied research in water policy and practice, including recent studies of private sector involvement in relation to water, both water resources management-WRM (at river/aquifer) (e.g. Newborne and Mason, 2012) and water supply, sanitation and hygiene-WASH (taps/toi...

Introduction: The incidence of chronic disease and treatment costs have been steadily increasing in the United States over the past few decades. Primary prevention and healthy lifestyle counseling have been identified as important strategies for reducing health-care costs and chronic disease prevalence. This article seeks to examine decision-makers’ experiences and self-perceived roles in guideline and lifestyle counseling implementation in a primary care setting in the United States. Methods: Qualitative interviews were conducted with administrators at a health-care network in Upstate New York and with state-level administrators, such as insurers. Decision-makers were asked to discuss prevention guidelines and healthy lifestyle counseling, as well as how they support implementation of these initiatives. Interviews were analyzed using a thematic analysis framework and relevant sections of text were sorted using a priori codes. Results: Interviews identified numerous barriers to guideline implementation. These included the complexity and profusion of guidelines, the highly politicized nature of health-care provision, and resistance from providers who sometimes prefer to make decisions autonomously. Barriers to supporting prevention counseling included relatively time-limited patient encounters, the lack of reimbursement mechanisms for counseling, lack of patient resources, and regulatory complexities. Conclusions: Our research indicates that administrators and administrative structures face barriers to supporting prevention activities such as guideline implementation and healthy lifestyle counseling in primary care settings. They also identified several solutions for addressing existing primary prevention barriers, such as relying on nurses to provide healthy lifestyle support to patients. This article provides an important assessment of institutional readiness to support primary prevention efforts.

A multidisciplinary group recently came together at Tavistock Square in London in an effort to prepare a shared code of ethics (pages 32-33), reproduced here in full with an accompanying commentary by June Andrews, RCN Scottish secretary.

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