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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;
  • Diabetic Medicine 10/2013; 30(10):1156-9.
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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.
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    ABSTRACT: Structured diabetes care can improve outcomes and reduce risk of complications, but improving care in a deprived, ethnically diverse area can prove challenging. This report evaluates a system change to enhance diabetes care delivery in a primary care setting. All 35 practices in one inner London Primary Care Trust were geographically grouped into eight networks of four to five practices, each supported by a network manager, clerical staff and an educational budget. A multidisciplinary team developed a 'care package' for type 2 diabetes management, with financial incentives based on network achievement of targets. Monthly electronic performance dashboards enabled networks to track and improve performance. Network multidisciplinary team meetings including the diabetic specialist team supported case management and education. Key measures for improvement included the number of diabetes care plans completed, proportion of patients attending for digital retinal screen and proportions of patients achieving a number of biomedical indices (blood pressure, cholesterol, glycated haemoglobin). Between 2009 and 2012, completed care plans rose from 10% to 88%. The proportion of patients attending for digital retinal screen rose from 72% to 82.8%. The proportion of patients achieving a combination of blood pressure ≤140/80 mm Hg and cholesterol ≤4 mmol/L rose from 35.3% to 46.1%. Mean glycated haemoglobin dropped from 7.80% to 7.66% (62-60 mmol/mol). Investment of financial, organisational and education resources into primary care practice networks can achieve clinically important improvements in diabetes care in deprived, ethnically diverse communities. This success is predicated on collaborative working between practices, purposively designed high-quality information on network performance and engagement between primary and secondary care clinicians.
    BMJ quality & safety 09/2013;
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    ABSTRACT: This study explores how African, Caribbean and White British women worked to hide psychological partner abuse as they experienced it, "do gender," and appear competent in social roles. They prioritized negotiated competencies as "good partners," actively setting socially and culturally embedded boundaries to their abuser's behaviors: an inner boundary encompassing normal behaviors and an outer one of "acceptable" behaviors projected as normal through remedial work. Behaviors breaching the outer boundary (e.g., if the women narrowed the bounds of the "acceptable") compromised the women's competence. This sometimes led them to actively use support services. Appropriate advice and support may change the boundaries.
    Violence Against Women 09/2013; 19(9):1104-32.
  • Evidence-based medicine 07/2013;
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    ABSTRACT: Alcohol consumption in western pregnant women is not uncommon and could be a risk factor for childhood atopic disease. However, reported alcohol intake may be unreliable, and associations are likely to be confounded. We aimed to study the relation between prenatal alcohol exposure and atopic phenotypes in a large population-based birth cohort with the use of a Mendelian randomization approach to minimize bias and confounding. In white mothers and children in the Avon Longitudinal Study of Parents and Children (ALSPAC) we first analyzed associations between reported maternal alcohol consumption during pregnancy and atopic outcomes in the offspring measured at 7 years of age (asthma, wheezing, hay fever, eczema, atopy, and total IgE). We then analyzed the relation of maternal alcohol dehydrogenase (ADH)1B genotype (rs1229984) with these outcomes (the A allele is associated with faster metabolism and reduced alcohol consumption and, among drinkers, would be expected to reduce fetal exposure to ethanol). After controlling for confounders, reported maternal drinking in late pregnancy was negatively associated with childhood asthma and hay fever (adjusted odds ratio [OR] per category increase in intake: 0.91 [95% CI, 0.82-1.01] and 0.87 [95% CI, 0.78-0.98], respectively). However, maternal ADH1B genotype was not associated with asthma comparing carriers of A allele with persons homozygous for G allele (OR, 0.98 [95% CI, 0.66-1.47]) or hay fever (OR, 1.11 [95% CI, 0.71-1.72]), nor with any other atopic outcome. We have found no evidence to suggest that prenatal alcohol exposure increases the risk of asthma or atopy in childhood.
    The Journal of allergy and clinical immunology 06/2013;
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    Journal of epidemiology and community health 06/2013; 67(6):e1.
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    ABSTRACT: BACKGROUND: Identifying patients with chronic musculoskeletal pain using database searches is difficult, as chronic pain is not represented with a unique diagnostic code in electronic primary care records. Aim This paper describes the development and implementation of a search strategy to identify patients with chronic musculoskeletal pain in primary care databases to invite them to participate in a randomised controlled trial. METHODS: We used an exploratory, iterative approach. The first phase involved consultations with IT specialists, practice managers and doctors to gain an understanding about the processes and issues of electronic coding. In the second and third phases, we determined the most appropriate search terms and strategies. In the final phase, we tested, modified and re-tested the search strategy until the quantity and quality of the output appeared good enough to be used in general practices with different IT systems. This strategy was then implemented to recruit participants for a trial. Findings We identified three main search 'domains': prescribing, coding and attendance. We found the most useful identifier for chronic pain was the use of repeat medication. Wide variations in coding terms for chronic pain were seen between practices and individuals. Understanding 'coding cultures' were necessary to inform the electronic searches. In the case of chronic pain, searching on repeat medication for analgesia, low dose antidepressants and carefully selected coding terms captured most relevant patients.
    Primary Health Care Research & Development 05/2013;
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    ABSTRACT: Biomedical health services and health systems research require timely, complete, accurate and accessible data relating to geographical populations in order to facilitate needs assessment and planning of medical care, new medicines and technology. The international trend towards competition and privatisation has largely proceeded as if data generation were immune to market fragmentation and loss of universal coverage. By examining recent reforms to the English National Health Service, the authors show that this is not the case. Routine and population data are products of administrative systems and the nature, completeness and quality of data available to clinical and public health researchers are substantially impaired by market reforms.
    Evidence-based medicine 05/2013;
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