Practices and values regarding milk consumption among pre-schoolers in Bangkok.

PURPOSE: Thai government agencies and the business sector have been promoting milk consumption. Considering the robust and continual movements by those actors to promote milk consumption among children in Thailand at the national level, this study aims to investigate milk-consumption practices and values towards milk consumption at pre-school, family and individual levels. METHODS: This cross-sectional qualitative study employs observation and interview methods, along with the Ecological System Theory as a framework. Data were collected from three kindergartens used by families of varying socio-economic status, and the homes of 18 pre-schoolers, aged 3-5 years old, attending these kindergartens, from October 2013-September 2014. RESULTS: Findings reveal kindergartens implemented daily routines to make children drink milk. Practices at home include (i) overfeeding of milk, (ii) preference for fortified milk and (iii) using sweetness to make children drink milk. These practices were underpinned by values that milk is good for children and good parents feed their children milk. These values, in combination with other macro-level measures such as the government's milk-promotion campaigns and the milk industry's marketing, influence the milk-drinking practices of pre-schoolers. CONCLUSION: The promotion of the benefits of milk prompted children to exceed the recommended milk consumption of 400ml per day. Balanced information on moderation in milk drinking was absent.

A case study exploring employment factors affecting general practice nurse role development.

AIM: The aim of this study was to explore the factors affecting role development in practice nursing in the United Kingdom. BACKGROUND: General practice is currently central to National Health Service reform, producing favourable conditions for the practice nurse role to be further strengthened and developed. However, the literature has continued to describe evidence that practice nurses are a disempowered, isolated group with many constraints reducing their ability to respond to opportunities to develop their role. The rationale for conducting the study was therefore to provide a greater understanding about the constraining factors and their influence on practice nurses wishing to develop their role. METHOD: The method used to conduct the research followed a case approach, as the subject being investigated was complex with multiple inter-related factors and the approach was exploratory. The cases comprised six UK general practices and the participants within each case were a practice nurse, a GP and a practice manager. FINDINGS: A combination of factors was found to contribute to the way the practice nurse role evolves. These are education, practice culture, practice nurse personal characteristics and empowerment. Empowerment holds the key to maximising the conditions favourable to practice nurse role evolution. This is not, however, a 'single' factor; it represents the combined synergistic effects of practice culture and practice nurse personal characteristics on creating an empowering environment. The inter-relationship between these was captured in a framework and given the title 'empowering employment principles'. CONCLUSION: The 'empowering employment principles' illustrate the features most conducive to role evolution, thus providing a tool for practice nurses and their employers to enhance opportunities for nurses to develop their role.

Living with hepatitis C: a phenomenological study.

AIMS AND OBJECTIVES: To explore the experience of adults living with hepatitis C over time. BACKGROUND: Hepatitis C virus is a growing problem affecting thousands of people worldwide. The majority of individuals infected develop chronic liver disease, but treatment is not always successful, leaving many to live with the virus indefinitely. Experiences of living with hepatitis C are poorly understood yet essential to meet the needs of an increasing number of affected people. DESIGN: A qualitative study using a descriptive phenomenological methodology. METHODS: Unstructured interviews were conducted with 23 hepatitis C-positive individuals in the East of England; participants were interviewed twice within a year. RESULTS: Data analysis revealed six themes of the experience of living with hepatitis C: hepatitis C and self; hepatitis C, self and others; self and handling hepatitis C; self and handling hepatitis C treatment issues; living with the consequences of hepatitis C; self, hepatitis C and thoughts of the future. CONCLUSIONS: Diagnosis of hepatitis C can disrupt people's sense of identity and trigger a life transition. A complex range of factors create uncertainty for people living with hepatitis C. Many struggle to make a healthy transition to life with the condition, instead living in a state of sustained uncertainty. RELEVANCE TO CLINICAL PRACTICE: Nurses working within a chronic care framework of ongoing advice and support can improve experiences for those living with hepatitis C. Practice aimed at reducing both the disruptive effect of the diagnosis and the uncertainties it creates can help facilitate a transition to life with the disease.

Patients' perception of the nursing contribution to gastric band surgery.

Gastric banding is an established and effective form of weight-loss surgery. However, the nursing contribution to it remains largely unexplored. Using semi-structured interviews, this study explored the experiences and opinions of 20 purposively recruited patients about their nurses' contribution to weight-loss surgery. The data were analysed using thematic analysis. Three themes emerged. First, the provision of knowledge and fostering of understanding, both before and after surgery, focusing on information that addresses patients'needs. Second, staying in touch throughout the treatment period,being available whenever problems arise and advice or interventions are needed. The third theme concerned qualities demonstrated by the nurses. Open-minded patient engagement combined with person centered care fostered confidence in patients and promoted a close therapeutic relationship. Nurses make a substantial contribution to weight-loss surgery, caring for their patients' physical, surgical and,most importantly, psychosocial needs. Their role descriptions should emphasise the psychological, supportive aspects of this role.

Adherence to home physiotherapy treatment in children and young people with joint hypermobility: a qualitative report of family perspectives on acceptability and efficacy.

OBJECTIVE: Joint hypermobility can lead to pain and motor developmental problems in children and young people (CYP). Exercise programmes may help CYP with joint hypermobility strengthen core muscle groups. Non- adherence to home physiotherapy is common. The present study aimed to understand how families experienced an intensive multidisciplinary intervention. METHOD: This was a qualitative study nested within a randomized controlled trial of a multidisciplinary treatment intervention, including physiotherapy, for children aged five to 17 years. Twenty-eight families were recruited following the intervention. Semi-structured interviews were used to examine the views and expectations of parents and CYP, and examine adherence to the exercise programme. Thematic analysis of data was used to develop findings. RESULTS: Parents and CYP reported that exercise reduced the symptoms of hypermobility. Parental motivation, adapting family routines, making exercise a family activity and seeing benefit increased adherence to exercise. Non-adherence to exercise was linked to lower levels of parental supervision, not understanding the treatment, not seeing benefit and not having specific time to dedicate to doing the exercises. CONCLUSION: Even when exercise is seen to benefit a child's well-being, families experience challenges in adhering to a physiotherapy programme for hypermobility. Therapists can utilize findings on what enhances adherence to help CYP effectively exercise in the home setting.

Living with a Gastric Band: A Qualitative Study.

UNLABELLED: Gastric banding is an established and effective form of weightloss surgery. Semi-structured interviews explored the experiences of gastric banding of twenty purposively recruited patients one year after surgery. Data was analysed using thematic analysis. RESULTS: Three themes emerged. They included 'Exercising choice' (restriction by the band was counterbalanced by new food-related choices.); 'Rediscovering life' (improved health, physical ability and energy enabled the patients to re-discover life.) and 'Goals achieved with no regrets' (patients had nearly achieved their self-set goals.) CONCLUSION: Beyond achieving weight loss and improved health, the participants had improved quality of life as defined by patients. Knowledge about this active process informs the care of these patients.

How do patients with end-stage ankle arthritis decide between two surgical treatments? A qualitative study.

OBJECTIVE: To examine how patients decide between ankle fusion and ankle replacement in end-stage ankle arthritis. DESIGN: Purposive patient selection, semistructured interviews, thematic analysis. SETTING: Royal National Orthopaedic Hospital, Stanmore, UK. PARTICIPANTS: 14 patients diagnosed with end-stage ankle osteoarthritis. RESULTS: We interviewed 6 men and 8 women with a mean age of 58 years (range 41-83). All had opted for surgery after failure of at least 6 months of conservative management, sequentially trading-off daily activities to limit the evolving pain. To decide between two offered treatments of ankle fusion and total ankle replacement (TAR), three major sources informed the patients' decision-making process: their surgeon, peers and the internet. The treating surgeon was viewed as the most reliable and influential source of information. Information gleaned from other patients was also important, but with questionable reliability, as was information from the internet, both of which invariably required validation by the surgeon and in some cases the general practitioner. CONCLUSIONS: Patients seek knowledge from a wealth of sources including the internet, web forums and other patients. While they leverage each of these sources to guide decision-making, the most important and influential factor in governing how patients decide on any particular surgical intervention is their surgeon. A high quality doctor-patient relationship, coupled with clear, balanced and complete information is essential to enable shared decision-making to become a standard model of care.

Factors influencing HIV screening decisions for pregnant migrant women in South East Asia.

BACKGROUND: universal screening in pregnancy for HIV is common and migrant women are an identified high risk group. The increasing mobility within countries and migration across borders affects the growing prevalence of HIV, but little is understood about how migrant women view risk of HIV in relation to pregnancy. OBJECTIVES: to explore factors that relate to HIV screening decisions for migrant women. DESIGN: the HIV antenatal counselling experiences of pregnant migrant women were explored in a Grounded Theory study. SETTINGS: the four settings were antenatal care units of border hospitals in northern Thailand PARTICIPANTS: 38 migrant pregnant women who had been through the HIV screening process at participating antenatal clinics as well as 26 health personnel at the units were purposively recruited and interviewed about their experiences and attitudes to HIV counselling and testing for this group. METHODS: in-depth interviews were conducted from January to March 2008. The grounded theory technique of open coding was employed and constant comparison took place throughout until saturation was achieved. FINDINGS: four themes were identified as common to the women and the health professionals: ineffective provision of information; internal and external barriers to information; implications of migrant status; and perception of risk. CONCLUSIONS: where language barriers exist interpreters are required and creative approaches to information giving that do not rely on text are necessary. The organisation of clinics does not currently meet the needs of migrant women and causes stress for health staff due to time constraints. Extra resources should be focussed where there are large numbers of migrants.

The Patient Journey to Gastric Band Surgery: A Qualitative Exploration.

AIMS: This study explored the views and experiences of obese people preparing to undergo laparoscopic gastric banding (LAGB) leading up to the time of surgery. BACKGROUND: Weight loss surgery (WLS) is the most successful intervention available for the treatment of morbid obesity, and LAGB is among the most commonly used procedures in bariatric surgery. So far, the patient experience of deciding to undergo LAGB has been explored rarely and predominantly retrospectively. DESIGN: Semi-structured interviews took place with 23 patients about to undergo LAGB between June 2011 and March 2012. Data were analyzed using thematic analysis. Demographic and quality of life data situated the sample within the LAGB patient population. RESULTS: Three overarching themes were described. Participants were "living with obesity," including the physical, social, and psychological challenges and consequences of being obese. These created in them a "desire to change," expressed in multiple unsuccessful attempts to lose weight, and a quest for information, finally focusing on WLS. Eventually, "expectations toward LAGB" were formed, mainly to hand back a measure of control that enabled them to achieve, as well as ultimately to maintain, weight loss. This active process resulted in the patients' decision to undergo LAGB. When combined, these themes outline a distinct patient journey toward gastric banding. CONCLUSION: Knowledge of the patient journey can inform both selection and care of patients awaiting gastric band surgery and is required by all health professionals working with this patient group.

The use of carer assisted adherence therapy for people with Parkinson's disease and their carers (CAAT-PARK): study protocol for a randomised controlled trial.

BACKGROUND: Pharmacological intervention is essential for managing the symptoms of Parkinson's disease. Adherence to medication regimens however is a major problem. Poor adherence leads to significant motor deterioration and inadequate symptom control. This results in poor quality of life. Whilst interventions to improve medication adherence have shown considerable benefit in other chronic conditions, the efficacy of such treatments in Parkinson's disease is less well researched. Many people with Parkinson's disease require substantial support from spouse/caregivers. This often extends to medication taking. Consequently, spouse/caregiver's support for timely medication management is paramount. We aim to investigate the benefit of a novel intervention, Carer Assisted Adherence Therapy, for improving medication adherence and quality of life in people with Parkinson's disease. Adherence therapy may help to optimise the efficacy of anti-parkinsonian agents, subsequently improving clinical outcomes. METHODS/DESIGN: A parallel, randomised controlled trial will be conducted to investigate whether carer assisted adherence therapy is effective for improving medication adherence and quality of life. We aim to recruit 40 patient/carer pairs into each group. Participants will be randomly assigned by the Clinical Research Trials Unit at the University of East Anglia. Adherence therapy is a brief cognitive-behavioural approach aimed at facilitating a process of shared decision making. The central theory is that when patients make shared choices with a professional they are more likely to continue with those choices because they are personally owned and meaningful. Outcomes will be rates of adherence and quality of life, determined by the Morisky Medication Adherence Scale-4 and the Parkinson's disease Questionnaire-39 respectively. Assessments will take place post randomisation, immediately post intervention and 12-weeks post randomisation. Primary outcomes are adherence and quality of life at 12-week follow-up. Efficacy will be determined using intention-to-treat analysis. Independent samples t-tests will compare mean changes between groups from baseline to follow-up. Per protocol analysis will be conducted based on individuals with no major protocol deviation. Where imbalances in baseline characteristics are identified, an adjusted analysis will be performed using a regression model. Analysis will be masked to treatment allocation. TRIAL REGISTRATION: ISRCTN: ISRCTN07830951.

Parents' experience of giving consent for their child to undergo surgery.

This study considered the experiences of parents giving consent for their children to undergo surgery at a regional centre for paediatric surgery. Eighteen purposively selected parents whose children had undergone surgery were interviewed for this qualitative study. All parents wanted to receive understandable but comprehensive information, they expected opportunities to ask questions and wanted to be given sufficient time to make their decision. Their reactions to being given the information varied, with some parents' anxiety levels increasing, while others felt re-assured. Most parents were willing to give their consent only once they had been convinced of the need for surgery. On the other hand, two parents wanted the surgeon to decide for them. Many parents also wanted to share the responsibility and give consent together. The main outcome of this study was that the parents' decisions and decision-making was more individualised than previously thought.

Weight loss surgery for morbidly obese adolescents: a review.

Obesity is common among adolescents resulting in substantial comorbidities and reduced life expectancy. Conservative treatments normally fail to ensure significant and sustained weight loss and suitable adolescents should be offered weight loss surgery. Laparoscopic Adjustable Gastric Banding and Roux-en-Y Gastric Bypass are commonly used in adolescents. Complications in RYGB tend to be more severe, but the procedure leads to more immediate results. LAGB complications are often device-related and less severe. Dietary adherence, eating behaviour and unrealistic patient expectations often cause problems. Significant and sustained weight loss of 50-70 per cent of excess weight is achievable, comorbidities and psychological problems improve. Meticulous patient selection and preparation and good post-operative care are vital for successful weight loss surgery. Weight loss surgery is safe, effective and economically viable with nurses playing a vital role at all stages of its application.

A Depression Recognition and Treatment package for families living with Stroke (DepReT-Stroke): study protocol for a randomised controlled trial.

BACKGROUND: Depression occurs in up to 50% of patients after stroke and limits rehabilitation and recovery. Mood disorders are also highly prevalent in carers; their mental health intertwined with the physical and mental wellbeing of the person they are caring for. We argue that working with families, rather than patients alone may improve the treatment of depression in both patients and their carers enhancing the mental wellbeing and quality of life of both. METHODS: A single blind cluster randomised controlled trial to evaluate whether families after stroke who are treated with the Depression Recognition and Treatment package (DepReT-Stroke) in addition to treatment as usual (TAU) show improved mental well being compared to those families who receive only TAU. We aim to recruit one hundred and twenty-six families (63 in each group). The DepReT-Stroke intervention will help families to consider the various treatment options for depression, make choices about which are likely to fit best with their lives and support them in the use of self-help therapies (e.g. computerised Cognitive Behavioural Therapy or exercise). An essential component of the DepReT-Stroke package will be to help people adhere to their chosen treatment(s). The primary outcome will be the Mental Component Subscale of the SF-36 assessed at baseline and again six months post intervention. Effectiveness of the intervention will be determined using analysis of co-variance; comparing the mean change in MCS scores from baseline to six months follow-up adjusting for the clustering effects of baseline scores and family. An economic evaluation of the intervention will help us determine whether the intervention represents a cost-effective use of resources. DISCUSSION: Depression both for patients and their carers is common after stroke. Our Depression Recognition and Treatment package (DepReT-stroke) may help clinicians be more effective at detecting and managing a common co-morbidity that limits rehabilitation and recovery. TRIAL REGISTRATION: ISRCTN: ISRCTN32451749 Research Ethics Committee Reference Number: 10/H0310/23 Grant Reference Number: (NIHR) PB-PG-0808-17056.

Attitudes of adolescents and parents towards premarital sex in rural Thailand: a qualitative exploration.

OBJECTIVE: This qualitative study aimed to explore attitudes of Thai parents and adolescents towards premarital sex. STUDY DESIGN: Data were collected from 11 focus groups with 30 Thai parents and 36 adolescents aged 15-19 years old in rural areas of Udon Thani province, Thailand and examined using thematic analysis. RESULTS: Four themes were identified from the data: the social judgement of girls; boys have nothing to lose; considering risks and parents as problem solvers. All themes relate to the continuing existence of double standards concerning the social norm for premarital sex as applied to young women on one side and young men on the other. CONCLUSIONS: The influence of traditional values is still very strong in rural north-eastern Thailand. The findings highlight teenagers' need for more support from their parents. The promotion of open, honest communication between parents and teens is important to overcome difficulties of social judgements and align thinking between old and new social values.

Research in prison: a researcher-practitioner's view.

The prevalence of physical and mental health problems is high in prisoners compared with the general population, although health services are closing the gaps. These disparities and the unique setting make for a potent environment for research into offender health. However, conducting research in prison does present difficulties. This paper presents an 'insider's' view of the process, from setting up a qualitative research project through to obtaining relevant approvals and support in this paradoxical world of regulatory bodies.

Why Thai parents do not discuss sex with their children: a qualitative study.

This qualitative article explores the attitudes of Thai adolescents and parents concerning the barriers that prevent parents providing sex education to their adolescent children. Focus groups were conducted with 30 parents and 36 adolescents in rural north-eastern Thailand and were analyzed by using thematic analysis. The results showed that most Thai parents have not taught their children about sex education issues. Five themes emerged in relation to the limitations in providing sex education in Thai families. These were: restrictions imposed by traditional Thai culture; sex education is not a parental duty; parental limitations; the generation gap; and better not bring it up. We conclude that the core values in Thai society restrict the discussion of sex, resulting in youth missing the opportunity to acquire the knowledge that is needed about sexual issues from their family. This article provides evidence of how parents' knowledge and perceptions are linked to their ability and willingness to discuss sexual matters with their teenagers. Therefore, future sex education policies could be greatly enhanced by empowering parents to take part in the sex education of their teenage children.

Depression and stroke: a common but often unrecognized combination.

Stroke is an extremely common rapid onset medical emergency that can cause permanent neurological damage. Depression is very common in both stroke survivors and their carers, but it is frequently overlooked in both groups. Nurses can make a substantial improvement to patient care by not only being aware of this issue, but also by making an active contribution to the detection of depression in stroke survivors and their carers. The mental health of carers is intertwined with the mental health and disease presentation of the patient. A family centred approach with a dual focus on the stroke survivor and the carer is therefore needed to maximize success in post-stroke care. Nurses can teach families to recognize depression and assist them to accept treatment. They can use the Patient Health Questionnaire 9-item depression scale (PHQ-9) as probably the most suitable screening and diagnostic tool for both groups. Nurses can play a role in destigmatizing the diagnosis and the link between symptoms of depression and treatment. Finally, nurses can play an important part in initiating, monitoring and adjusting treatment.

Home next day: early discharge of children following appendicectomy.

Fifty-six children in two groups were discharged within 24 hours of an uncomplicated appendicectomy. While the children in the first group (N = 21) were visited by a nurse at home within 24 hours of discharge, the second group (N = 35) just received telephone calls. The cohort was evaluated by telephone interviews two weeks after discharge. All children fulfilling the discharge standards were discharged safely within 24 hours of surgery. Any physical complaints post-discharge were considered minor. The nurses were able to provide reassurance to the families, give advice and deal with minor problems. As a result the families felt safe and reassured, and in only one case did the fragility of parental confidence become obvious. This study has demonstrated the safety of discharging these children within 24 hours of surgery and the value to nursing contacts in enabling the families to care for their children at home.

Genetics knowledge for nurses: necessity or luxury?

Senior nurses within frontline NHS Trusts in East Anglia were consulted about their perceptions of the genetics-related knowledge and education required by nurses working in their Trusts. They disagreed with policy decision makers, i.e. the Government and genetics specialists, on the currently necessary knowledge levels. They also did not recognize genetics as an important issue in current everyday nursing activities. The difference in perception also related to the speed with which its presence and importance will increase. Nurses already working under considerable pressure while not perceiving the importance of genetics in everyday practice cannot be expected to willingly absorb new genetics-related knowledge. The National Genetics Education and Development Centre in Birmingham will have to reach out to practitioners and managers throughout the UK and establish a shared platform from which to develop this issue in the future.