Suggestions for assessment of muscle mass in primary care setting

Sarcopenia is one of the prevalent geriatric syndromes that adversely affects the functionality in the older adults. The diagnosis of sarcopenia requires documentation of decreased muscle mass and decreased muscle strength or physical function. The implication of user-friendly and inexpensive methods that could be used to assess sarcopenia in real-life settings is suggested in a recent debate paper. For muscle mass assessment, bioelectric impedance analysis (BIA), and dual-energy X-ray absorptiometry (DXA) were described as having the same ease for muscle mass assessment in terms of applicability. However, BIA is easier to perform, has greater availability, inexpensive, and does not require specialist trained staff. The authors proposed the use of DXA as primary tool to assess muscle mass in the primary care setting. However, BIA is recommended as a first-line method both in research and clinical practice by EWGSOP. Regarding its much easier applicability, we conclude that BIA is a more practical method for muscle mass assessment in the primary care setting than the DXA. Thus, we suggest that BIA could be the method of choice for muscle mass assessment in the primary care setting.     

Differences in childhood sexual abuse experience between adult Hispanic and Anglo women in a primary care setting

The literature on racial and ethnic factors in childhood sexual abuse is limited. The purpose of this exploratory study was to document Hispanic-Anglo differences in childhood sexual abuse experiences and assess whether these differences may be explained by socio-demographic and family environmental differences. Adult Hispanic (n = 69) and Anglo (n = 19) women from a family medicine clinic waiting room reporting a history of childhood sexual abuse completed an in-depth survey concerning the sexual abuse experience and their childhood environment. In this study, Hispanics were more likely to report a family member as the perpetrator and to experience more self-blame as a result of the abuse. Hispanics were also more likely to take action in response to the abuse, especially those who were more acculturated to U.S. culture. However, most of the observed differences in this study could be explained by socio-demographic or family environment variables, not by ethnic background. Qualitative research on the family environments of Hispanic victims of child sexual abuse may further explicate the dynamics and risk factors for abuse by family members.     

Albinism in Malawi: knowledge and beliefs from an African setting

This article is based on a qualitative project which has set out to examine knowledge, beliefs and behaviour related to people living with albinism in Malawi. Individual, in-depth interviews were carried out with 25 people with albinism and their family members. The findings show that most people with albinism, as well as their families, have very little knowledge about albinism, but many know and experience that the skin of people with albinism is very sensitive to the sun, and therefore take precautions to prevent injury. Stories of common myths were told, as well as stories of different relationships that are altered as a result of albinism. Stories were also told of love and approval of people with albinism. In Malawi people with albinism are considered, and consider themselves to be, disabled.     

Mental illness and help-seeking behavior among Mariel Cuban and Haitian refugees in south Florida.

Differences in psychopathology and use of the mental health system by recent refugee groups are explored in light of competing hypotheses stemming from theories of immigrant adaptation and minority mental health. Results show that would-be Haitian refugees arriving in South Florida during the early 1980s had relatively small needs for mental health care, but whatever needs they had were largely unattended by the health services system. Mariel Cubans had far greater needs that were mostly met satisfactorily by virtue of their familiarity with service facilities prior to departure and their incorporation into a favorable social environment. These contextual factors are added and compared with the individual-level predictor variables suggested by Andersen and others. The results' implications for theories of immigrant mental health and help-seeking and for the implementation of effective delivery programs are discussed.     

Intimate partner aggression perpetration in primary care chronic pain patients

This study examined the prevalence and correlates of partner aggression perpetration in 597 primary care chronic pain patients. Approximately 30% of participants reported perpetrating low-level aggression, 12% reported injuring their partner, and 5% reported engaging in sexual coercion. Women reported more low-level aggression perpetration than men, and men reported more engagement in sexual coercion than women. Substance use disorders (SUD) were associated with all outcomes, and both aggression victimization and lifetime ratings of posttraumatic stress disorder (PTSD) were associated with low-level aggression and injuries. In multivariate analyses, gender, aggression victimization, PTSD, and SUD evidenced associations with one or more outcomes. Findings indicate a need for aggression screening in this population and highlight avenues for intervention.     

Social Rights and Disability: the language of 'rights' in community care policies

Social rights and disability: the language of 'rights' in community care policies. The paper argues that what disabled people mean when they speak of 'rights' is relatively under-developed with regard to health and social services. Furthermore, while a claim of 'rights' is typically presented as a fairer alternative to the needs-based character of welfare policies, how such an approach would change the delivery of health and social care is unclear. The paper draws on a landmark test case in community care to explore the problems of a rights-based approach to social justice for disabled people. It demonstrates the weaknesses of rights, especially the more problematic 'social rights', and urges caution in seeking solutions to social problems through the courts. It ends by suggesting that, given the anecdotal evidence about local authorities' tightening their eligibility criteria in the light of the 'Gloucestershire case', that limits on coverage may be the trade-off for implementing rights.     

Research and Disability in a Local Community

This paper describes a study of the experience of disability in a local community. The study unfolded within a carefully constructed and collaborative framework, so that the people in whose interests the study was focused could inform its process, and take opportunities to benefit from it and each other. Outcomes included the establishment of a local support group, a family support project involving the University and the local community, and considerably developed understandings of neighbourhood support and the experiences of disability, most specifically from the point of view of carers. Finally, a model of community support service was proposed. In conclusion, the paper highlights the processes of local collaboration and research. It describes research in which the actions taken and proposed to improve local supports were informed by the ongoing processes of research, and in turn the research process itself was informed by the local experiences of participants.     

Patient satisfaction in primary health care: a literature review and analysis.

This paper reviews the literature on patient satisfaction in primary health care settings. Definitions and models of satisfaction are considered first. Attention is given to the conceptualization of satisfaction by investigators concerned about consumers in general as well as by researchers focusing on consumers of medical services. Research findings are discussed and used to develop a model of patient satisfaction. The measurement of patient satisfaction and the findings of empirical studies are then reviewed, including summaries of effect sizes. It is concluded that patient satisfaction information can provide a dependent measure of service quality and serves as a predictor of health-related behavior. Issues deserving further investigation and recommendations regarding research strategies are presented.     

The use of buspirone in primary care

1. Although clinical trials have demonstrated the effectiveness of buspirone in treating generalized anxiety disorder, more studies are needed to confirm its efficacy in treating other anxiety disorders, depression, behavior disorders, substance abuse disorders, movement disorders, and other medical conditions. 2. Clinicians prescribing buspirone must know its basic pharmacology, adverse effects, and dosing guidelines. 3. Buspirone appears to be an alternative attractive medication to traditional benzodiazepines due to its low addictive potential and lack of lethality.     

Perceptions of participants and staff of implementing a physical activity program in rural primary care

Addressing the lack of physical activity (PA) in rural adults is vital because of the role it plays in the risk for many chronic diseases. The purpose of the study was to explore the feasibility of conducting a 12-week intervention utilizing a Fitbit to increase PA behavior in inactive rural adults recruited from a primary care clinic. Semi-structured interviews were conducted with study participants (n=10) and a focus group was held with nurses (n=7) from the primary care clinic. Data were analyzed using the process of immersion/crystallization. Participants and nurses both felt the program had a positive impact on PA and that the program was needed in the community. Study participants most often reported their favorite part of the study was being able to track their activity as well as the goal setting. However, study participants reported barriers to continued participation in PA related to a lack of time and ability to be active in cold weather. Further, nursing staff reported barriers in regard to a lack of resources (staffing and money) These barriers need to be examined further and addressed in order to implement a sustainable PA program that can be maintained through a primary care clinic.