William Lauder

Prevalence and time trends in obesity among adult West African populations: a meta-analysis

The objective of this study was to determine the distribution of and trends in obesity in adult West African populations.

A comparison of health behaviours in lonely and non-lonely populations.

Abstract Loneliness can be defined as perceived social isolation and appears to be a relatively common experience in adults. It carries a significant health risk and has been associated with heart disease, depression and poor recovery after coronary heart surgery. The mechanisms that link loneliness and morbidity are unclear but one of the mechanisms may be through poor health beliefs and behaviours. The aims of this cross-sectional survey of 1289 adults were to investigate differences in health behaviours (smoking, overweight, BMI, sedentary, attitudes towards physical activity) in lonely and non-lonely groups. Lonely individuals were more likely to be smokers and more likely to be overweight – obese. The lonely group had higher body mass index scores controlling for age, annual income, gender, employment and marital status. Logistic regression revealed no differences in sedentary lifestyles. Lonely individuals were significantly less likely to believe it was desirable for them to lose weight by walking for recreation, leisure or transportation. The findings provide support for an association between health behaviours, loneliness and excess morbidity reported in previous studies.

Prevalence and time trends in diabetes and physical inactivity among adult West African populations: The epidemic has arrived

OBJECTIVE To determine the prevalence and distribution of, and trends in, physical inactivity and diabetes in adult West African populations. DESIGN Systematic review and meta-analysis. METHODS Literature searches were conducted using four electronic databases. Journal hand searches and examination of citations of relevant articles were also undertaken. To be included, studies had to be population based, use clearly defined criteria for measuring diabetes and physical inactivity, present data that allowed calculation of the prevalence of diabetes or physical inactivity, and sample adult participants. Studies retrieved were appraised critically. Meta-analysis was performed using the DerSimonian-Laird random effect model. RESULTS Twenty-one reports were retrieved for diabetes and 15 reports were retrieved for physical in/activity. Most studies (10 for diabetes and six for physical activity) were conducted solely among urban populations. The prevalence of diabetes in West Africa was approximately 4.0% [95% confidence interval (CI) 2.0-9.0] in urban adults and 2.6% (95%CI 1.5-4.4) in rural adults, and was similar in men and women [prevalence ratio (PR) 1.36, 95%CI 0.96-1.92]. Cumulative time trend analyses suggested an increase in the prevalence of diabetes among adults in urban West Africa, from approximately 3.0% (95%CI 1.0-7.0) to 4.0% (95%CI 2.0-9.0) in the past 10 years. The prevalence of inactivity in West Africa was 13% (95%CI 9.0-18.0). An association was found between physical inactivity and being older (> or = 50 years) (PR 1.82, 95%CI 1.36-2.44), female gender (PR 1.62, 95%CI 1.41-1.87) and urban residence (PR 2.04, 95%CI 1.58-2.63). CONCLUSIONS Diabetes and physical inactivity are important public health issues in urban West Africa, with similar prevalences to wealthy industrialized countries. There is an urgent need for policy makers, politicians and health promotion experts to put measures in place to encourage active lifestyles and control diabetes in urban West Africa.

Dr. John has gone: assessing health professionals' contribution to remote rural community sustainability in the UK

Due mainly to increasing difficulties in recruiting and retaining health professionals to work in remote and peripheral areas of Scotland, there is discussion of the need to implement new models of primary health care provision. However, innovative service models may imply a reduction in the number of health professionals who live and work in remote communities. Currently decisions about remodelling service provision are being taken by National Health Service stakeholders, apparently with little consideration of the wider social and economic impacts of change. This paper aims to argue that health professionals contribute to the fabric of rural life in a number of ways and that decisions about health service redesign need to take this into account. As well as fulfilling a wide health and social care role for patients, the authors seek to show that health professionals are important to the social sustainability of rural communities as, due to their unique position, they are often at the heart of networks within and between communities. The wider economic contribution of health services in remote communities is important, but often underplayed. The authors propose that theories of capital, principally the concept of social capital, could help in investigating the wider contribution of health professionals to their local communities. Ultimately, it is proposed that health services, as embodied in nurses, doctors and others, could be highly important to the ongoing livelihood and social infrastructure of fragile remote communities. Since this area is poorly understood, there is a need for prospective primary research and evaluation of service redesign initiatives.

An Improved Methodology for Advancing Nursing Research Factorial Surveys

Clinical judgments and decisions are an integral component of nurse work and nurses are increasingly being challenged to account for their judgments and decisions. Nursing research is needed to help explain judgment and decision making in nursing, but most research in this area is almost exclusively characterized by descriptive studies. This article describes the use of the factorial survey method, which combines the explanatory power of a factorial experiment with the benefits of a sample survey. This hybrid technique is an excellent method for studying judgments and decisions across settings, roles, disciplines, and countries. This article outlines the steps of the method and demonstrates its applicability with an exemplar from a study across nurses from 3 countries.

What do high academic achieving school pupils really think about a career in nursing: Analysis of the narrative from paradigmatic case interviews

As many Departments of Nursing within universities consider raising their academic entry requirements in an attempt to attract a more high academic achieving entrant and also endeavour to attract more school leavers one of the fundamental questions that needs to be answered is--are high academic achieving school pupils really interested in pursuing a career in nursing? The aim of this paper is to report on the findings from paradigmatic case interviews of high academic achieving school pupils who at one stage in their career choice process had considered nursing as a possible career choice but had ultimately disregarded nursing and had decided to pursue medicine or another health care profession. The study reports interview data from a sub-sample of (n=20) high academic achieving 5th and 6th year school pupils who participated in a larger survey of 5th and 6th year school pupils (n=1062). These were paradigmatic cases--high academic achieving school pupils who had considered nursing as a possible career choice within their career preference cluster but had ultimately disregarded nursing and decided to pursue medicine or another health care profession as a career choice. Participants reported that nursing was eventually not viewed as using their examination grades to the maximum benefit. Also the participants reported a belief that the work of the doctor is more important and academic as they cure patients whereas the work of the nurse is practical and routine as they only care for patients. The pupils in addition asserted a negative image of nursing and a low status level of nursing as a career. They also articulated the unremarkable typical school pupils they perceived would pursue nursing as a career choice and the type of school pupil that they had witnessed being encouraged toward nursing within their schools, both of which conflicted with their own typology. Ultimately the high academic achieving school pupils were doubtful and suspicious as to the credibility of a degree in nursing and nursing as a university programme. Nursing is a very contentious career choice consideration for high academic achieving school pupils. There is strong evidence from the interview data to suggest that attracting high academic achieving school pupils into nursing could be hugely problematic.

Why students leave in the UK: an integrative review of the international research literature

AIMS AND OBJECTIVES The purpose of this integrative review of the literature was to find and review international research studies that explored student attrition to determine what is known about the topic and to identify gaps in the research with a view to addressing the situation in the UK. BACKGROUND Attrition from nursing programmes is a serious problem in the UK. It is recognised as a complex phenomenon, not attributable to a single cause. Regardless of actual attrition rates and trends, departments of nursing are challenged to perform in a business-like manner. Consequently, every student lost to a programme of study equates to a financial penalty for the department and to the future workforce and community. DESIGN   Integrative review of the literature. METHOD Using electronic databases and specific search terms, 18 articles were identified and reviewed. Findings from the identified international research literature were analysed using qualitative content analysis. RESULTS Four broad themes that accounted for factors of relevance to attrition were identified: Social, Prediction, Programme and Personal. CONCLUSIONS Retention studies are fraught with methodological problems. These include incomplete or inaccurate data and low response rates. Attrition early in programmes may be attributed to a failure to understand the roles of nurses in contemporary societies. This has led to dissatisfaction with programmes and academic failure, as students may underestimate the intellectual demands of their programmes. Attrition later in the programme may be attributed to a combination of personal factors that culminate in a personal crisis. RELEVANCE TO CLINICAL PRACTICE The research literature suggests that stereotyping of nurses is a major factor in attrition. Both professions need to find ways of communicating contemporary roles to wider society.

Exploring the relationship between coping, social support and health-related quality of life for prostate cancer survivors: A review of the literature

OBJECTIVE Men affected by prostate cancer can experience profound physical and psychological sequalae; and unmet support needs are prevalent in men affected by this disease. Social support has been linked to improved health-related quality of life (HRQoL) and coping strategies, but little is known about the relationship between social support, coping and HRQoL for prostate cancer survivors. This review aims to identify the mechanism through which social support influences the relationship between coping and HRQoL for prostate cancer survivors. METHODS A literature review was conducted from the earliest date available to January 2013. Medline, CINAHL, PsycInfo, and ASSIA databases were searched using terms relevant to coping, social support and prostate cancer. Studies that explored the relationship between coping, social support and HRQoL were included. RESULTS 175 studies were assessed for potential inclusion with 11 publications included in this review. Studies predominately reported main effects of perceived social support on HRQoL, and few studies assessed moderation and mediation effects of coping and social support on HRQoL. Perceived social support was frequently assessed, but few studies evaluated the effects of received social support or satisfaction with social support on HRQoL. CONCLUSIONS The evidence base is under-developed at present. Future research should use a multidimensional inventory of the social support constructs to examine how each of the constructs influences the relationship between coping and HRQoL over time. This may facilitate the development of appropriately targeted social support interventions that are theoretically driven to address the unmet support needs of prostate cancer survivors.

Course-related family andfinancial problems of mature nursing students

In recent years there has been a significant change in the type of student entering nurse education. There has been a move towards widening access, and as a result, more mature students have gained entry to courses. What seems less clear is the types of course-related problems experienced by mature students. The study reported in this paper investigated the financial and family problems that mature students experience as a direct result of undertaking a course in nursing education. It was found that most mature students experience financial, childcare, relationship and family problems. It was also found that a large number of mature students thought about leaving the course as a result of these problems. It may be necessary, in the light of the findings, to consider how future course designs can accommodate mature students and their particular experiences.

Nurses’ judgements of self-neglect: a factorial survey

Self-neglect can be understood as the failure to engage in those activities which a given culture deems necessary to maintain a socially accepted standard of personal and household hygiene and carry out activities needed to maintain health status. Self-neglect is bound up in a discourse which equates dirt with disease and in which transgressions of self-care norms can be labelled as a medical syndrome. The notion of self-neglect as a social construction is the theoretical perspective which provides the framework for the study reported here. Judgements regarding self-neglect may be social judgements influenced by professional socialisation and cultural values. The belief that different groups of nurses may have different constructions of self-neglect will be investigated and the factors which influence these judgements will be explored in three groups of nurses. The inclusion of nursing students will allow some picture to emerge as to whether judgements develop over time or are relatively constant across the career path, albeit within the limitations of a non-longitudinal design.