GP perceptions of appraisal: professional development, performance management, or both?

GPs' perceptions of the tension between the professional development and revalidation aspects of the current GP appraisal scheme were analysed. Evidence was gathered from focus groups representing general practice in Northern Ireland. The results indicate that there is support for the professional development aspects of appraisal but the link with revalidation is problematic, thereby potentially undermining GP support for the scheme. Greater clarity about the precise nature of the linkage is required to avoid a process that fails to fully satisfy the requirements of either appraisal or revalidation.

A case control study of a deprivation triangle: teenage motherhood, poor educational achievement and unemployment.

Teenage motherhood has been linked with poor health, poor educational attainment, poor employment prospects and socio-economic deprivation. Much of the evidence has come from large surveys and the nature of these inter-relationships remains unclear. A case-control study was designed to compare the educational and employment experiences of teenage mothers with those of an age matched sample of peers from a similar social background and to test the feasibility of carrying out this type of research within primary care. Participants were identified from records in 36 GP practices in the Greater Belfast area. First time teenage mothers with one child aged 9-15 months at the time of interview were selected. Teenage mothers were matched with a control group of nulliparous teenagers in respect of age and postcode and registered with the same practice. Questionnaires were administered in their home or at their health centre. Data were analysed using SPSS for Windows Version 6. Teenage mothers were less likely than controls to have gained passes in school leaving examinations. None of the mothers was in full time education compared with 35% of the controls. Excluding those in education or training, more of the control group were employed at the time of study (82% v 11%). It is concluded that teenage mothers with one child report poorer educational attainment and employment status than their nulliparous peers from a similar social background with similar educational opportunities. Attention must be paid to these findings when planning policy to help teenage mothers and avoid perpetuation of a cycle of socio-economic deprivation.

Trends in dietary fiber intake in Japan over the last century.

BACKGROUND: Insufficient intake of dietary fiber (DF) is currently a major problem in the overall promotion of health in the general population in Japan. AIM OF THE STUDY: To analyze the time trends in DF intake, including DF density (total DF intake/1,000 kcal), and the ratio of water-insoluble fiber to water-soluble fiber (IS ratio) in Japan. METHODS: The time trend in DF intake in Japan was calculated from data compiled in the Japanese National Nutrition Survey. RESULTS: The mean daily DF intake (total DF intake) in 1952 was 20.5 g/day, which rapidly declined to about 70 % of the 1952 level in 1970, after which there was little change to 1998. DF density in 1952 was 9.7 g/1000 kcal, which declined by about 30 % in 1970, and remained at about the same level to 1998. The IS ratio has remained stable over this period. Whereas total DF intake and DF density in Japan are similar to those in Western countries, the IS ratios are higher in Japan. Therefore, the higher incidence of, and mortality from, colon diverticulosis, coronary heart disease, hyperlipidemia, etc., which are all thought to be related to fiber deficiency, in Western countries compared to Japan might be due to the differences in the IS ratio. CONCLUSIONS: A decline in total DF intake and DF density is predicted for Japan in the future, because these parameters were lower among the younger generation. This may be due to the marked changes in the dietary habits of the younger generation, and is a problematic trend for Japanese health.

Identification and referral of families at high risk for cancer susceptibility.

PURPOSE: Obtainment of family history and accurate assessment is essential for the identification of families at risk for hereditary cancer. Our study compared the extent to which the family cancer history in the physician medical record reflected that entered by patients directly into a touch-screen family history computer program. PATIENTS AND METHODS: The study cohort consisted of 362 patients seen at a comprehensive cancer center ambulatory clinic over a 1-year period who voluntarily used the computer program and were a mixture of new and return patients. The computer entry was assessed by genetics staff and then compared with the medical record for corroboration of family history information and appropriate physician risk assessment. RESULTS: Family history information from the medical record was available for comparison to the computer entry in 69%. It was most often completed on new patients only and not routinely updated. Of the 362 computer entries, 101 were assigned to a high-risk category. Evidence in the records confirmed 69 high-risk individuals. Documentation of physician risk assessment (ie, notation of significant family cancer history or hereditary risk) was found in only 14 of the high-risk charts. Only seven high-risk individuals (6.9%) had evidence of referral for genetic consultation. CONCLUSION: This study demonstrates the need to collect family history information on all new and established patients in order to perform adequate cancer risk assessment. The lack of identification of patients at highest risk seems to be directly correlated with insufficient data collection, risk assessment, and documentation by medical staff.