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    ABSTRACT: The inaugural Vitamin D and Human Health conference was held on the London Whitechapel campus of Queen Mary University's Barts and The London Medical School, from the 23rd to 25th of April, 2014. This three-day meeting set out to achieve two main aims: to create a forum for researchers to meet and forge new collaborations, and to provide a state-of-the-art overview of the latest findings from clinical research in the field of vitamin D. Over 300 clinical researchers, students and commercial representatives attended. Thirty international experts in the field of clinical vitamin D research presented talks organised into a programme spanning the human life course. Commencing with a session of talks providing overviews of randomised trials of supplementation and global vitamin D status, the meeting proceeded with a session on pre-birth related vitamin D research-evolution, genetics & fertility-which led into several talks in the area of child health. Sessions on respiratory health, immune function, cancer biology, and neurodegenerative diseases preceded an overview of research in the area of ageing-related health outcomes, including musculoskeletal health and metabolic diseases. Finally sessions on the economy of vitamin D and public health, along with future directions for research were held. Several themes emerged during the course of the meeting. The anticipation of results from very large (n > 5000) randomised controlled trials of vitamin D supplementation ("mega-trials") and Individual Patient Data (IPD) meta-analyses were hot topics of discussion. Mega-trials have the potential to detect small effect sizes of vitamin D supplementation on end-points such as incidence and mortality from cardiovascular disease and cancer. IPD meta-analyses have the potential to investigate the causes of heterogeneity often seen in the results of individual primary trials by allowing clinically important subgroup effects of vitamin D supplementation to be elucidated. The existence of a U-shaped relationship between vitamin D status and risk of certain health outcomes was another area of discussion. A third emerging theme, also relating to vitamin D dose-response relationships, was the potential differential effect of daily vs. intermittent bolus dosing on biological outcomes. Finally, the meeting also addressed strategies to tackle vitamin D deficiency at the population level, by alteration of sun-seeking behaviour, use of nutritional supplements and food fortification. The following 156 abstracts featured in the meeting as either a poster or an oral presentation. [...].
    Nutrients 07/2014; 6(7):2759-2919. DOI:10.3390/nu6072759
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    ABSTRACT: To explore general practitioners' (GP) perspectives on the meaning of 'timeliness' in dementia diagnosis. Narrative interview study. UK academic department of primary care. Seven practising GPs with experience of conveying a diagnosis of dementia. GPs' narrative commentaries of encounters with patients with suspected dementia were audio-recorded and transcribed resulting in 51 pages of text (26 757words). A detailed narrative analysis of doctors' accounts was conducted. Diagnosis of dementia is a complex medical and social practice. Clinicians attend to multiple competing priorities while providing individually tailored patient care, against a background of shifting political and institutional concerns. Interviewees drew on a range of explanations about the nature of generalism to legitimise their claims about whether and how they made a diagnosis, constructing their accounts of what constituted 'timeliness'. Three interlinked analytical themes were identified: (1) diagnosis as a collective, cumulative, contingent process; (2) taking care to ensure that diagnosis-if reached at all-is opportune; (3) diagnosis of dementia as constitutive or consequential, but also a diagnosis whose consequences are unpredictable. Timeliness in the diagnosis of dementia involves balancing a range of judgements and is not experienced in terms of simple chronological notions of time. Reluctance or failure to make a diagnosis on a particular occasion does not necessarily point to GPs' lack of awareness of current policies, or to a set of training needs, but commonly reflects this range of nuanced balancing judgements, often negotiated with patients and their families with detailed attention to a particular context. In the case of dementia, the taken-for-granted benefits of early diagnosis cannot be assumed, but need to be 'worked through' on an individual case-by-case basis. GPs tend to value 'rightness' of time over concerns about 'early' diagnosis.
    BMJ Open 03/2014; 4(3):e004439. DOI:10.1136/bmjopen-2013-004439
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    ABSTRACT: The English National Health Service Constitution states that patients have the right to expect all decisions about access to medicines and treatments to be made 'rationally'. Rationality in health care can be framed as instrumental, institutional or practical. In this article, we present a case example from an ethnographic study of the work of 'Individual Funding Request' panels to explore how rationality is enacted and accounted for in deliberations about the rationing of health care in the National Health Service. Our rhetorical analysis highlights how an embodied, practical rationality emerges as a significant aspect of rationality in practice, but at the same time has a problematic status in formal accounts of decision-making. We suggest that being both 'human' and 'rational' is a 'delicate balance' and creates a dilemma for Individual Funding Request panels. Aristotle's notion of phronesis provides a useful lens for theorising our observation of panel deliberations, and we argue for greater attention to the value of narrative ethics in helping us understand the challenges faced by resource allocators.
    Health 11/2013; 18(5). DOI:10.1177/1363459313507586
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    BMJ (online) 11/2013; 347(nov15 1):f6681. DOI:10.1136/bmj.f6681
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    ABSTRACT: To devise and test a self-management course for chronic pain patients based on evidence and underpinned by theory using the Medical Research Council (MRC) framework for developing complex interventions. We used a mixed method approach. We conducted a systematic review of the effectiveness of components and characteristics of pain management courses. We then interviewed chronic pain patients who had attended pain and self-management courses. Behavioural change theories were mapped onto our findings and used to design the intervention. We then conducted a feasibility study to test the intervention. Primary care in the inner city of London, UK. Adults (18 years or older) with chronic musculoskeletal pain. Related disability, quality of life, coping, depression, anxiety, social integration and healthcare resource use. The systematic reviews indicated that group-based courses with joint lay and healthcare professional leadership and that included a psychological component of short duration (<8 weeks) showed considerable promise. The qualitative research indicated that participants liked relaxation, valued social interaction and course location, and that timing and good tutoring were important determinants of attendance. We used behavioural change theories (social learning theory and cognitive behaviour approaches (CBA)) to inform course content. The course addressed: understanding and accepting pain, mood and pain, unhelpful thoughts and behaviour, problem solving, goal setting, action planning, movement, relaxation and social integration/reactivation. Attendance was 85%; we modified the recruitment of patients, the course and the training of facilitators as a result of testing. The MRC guidelines were helpful in developing this intervention. It was possible to train both lay and non-psychologists to facilitate the courses and deliver CBA. The course was feasible and well received.
    BMJ Open 11/2013; 3(11):e003534. DOI:10.1136/bmjopen-2013-003534
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    ABSTRACT: The purpose of this study was to test the extent that constructs from two theoretical models (self-regulatory theory and social cognitive theory) mediated change in outcomes following a self-management intervention. One hundred and twenty four individuals with type 2 diabetes who had participated in a randomised controlled trial of a diabetes self-management programme were analysed for the extent that illness beliefs and self-efficacy mediated change in self-management behaviours and illness specific quality of life. Exercise specific self-efficacy significantly mediated change in exercise at three months (B = .03; .01, p < .05) while monitoring specific self-efficacy mediated change in monitoring behaviour at both three (B = .04; .01, p < .01) and nine months follow-up (B = 5.97; 1.01, p < .01). Belief in control over diabetes mediated change in illness specific quality of life at three months (B = -.07; .28, p < .05) and nine months (B = .79; .28, p < .01) follow-ups, as well as change in exercise behaviour at immediately post-intervention (B = -.12; .17, p < .05). Behaviour-specific self-efficacy may have a stronger role in mediating self-management behaviours than illness beliefs; however, belief in control over diabetes may be important to manipulate for change in quality of life. This suggests different theoretical constructs may mediate change dependent on outcome.
    Psychology Health and Medicine 10/2013; 19(5). DOI:10.1080/13548506.2013.845301
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    ABSTRACT: David McCoy and colleagues critique the dominance of “lives saved” models of assessing the impact of health programs, using The Global Fund as a case study. Please see later in the article for the Editors' Summary
    PLoS Medicine 10/2013; 10(10):e1001522. DOI:10.1371/journal.pmed.1001522
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    Diabetic Medicine 10/2013; 30(10):1156-9. DOI:10.1111/dme.12300
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    ABSTRACT: Little sociological attention has been given to the role of think tanks in health policy and planning. Existing work in political science and public administration tends to define and categorise think tanks and situate them as a disinterested source of policy expertise. Despite the increasingly visible presence of think tanks in the world of health care, such work has done little to reveal how they operate, by whom and to what ends. Our article seeks to redress this firstly by examining why they have remained relatively hidden in academic analyses and secondly by advocating an interpretive approach that incorporates think tanks within the wider landscape of health policy and planning. In contrast to most existing literature, an interpretive approach acknowledges that much of the messy business of healthcare policy and planning remains hidden from view and that much can be gleaned by examining the range of organisations, actors, coalitions, everyday activities, artefacts and interactions that make up the think tank stage and that work together to shape health policy and planning. Given the paucity of research in this area, we urge the medical sociology community to open the field to further academic scrutiny.
    Sociology of Health & Illness 09/2013; 36(3). DOI:10.1111/1467-9566.12071
  • BMJ (online) 09/2013; 347:f5429. DOI:10.1136/bmj.f5429
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