Obesity is a major public health issue because of its increasing prevalence and impact on health. The management of overweight and obesity has been a government priority for many years. However, overweight and obesity management at a local level has often been ineffective. Although there is a need to examine obesity strategies and policies for local populations, there is currently no readily available framework for evaluating local obesity strategies. We therefore developed a framework, the Imperial College Obesity Strategy Assessment Framework (IC-OSAF), for examining the content of local obesity strategies.

We adapted two previous policy analysis frameworks (Bardach’s Eightfold Path Framework and Collins’ Health Policy Analysis Framework) and used these with information from national guidelines to develop an obesity strategy analysis framework. We then piloted this framework using the obesity strategy for one London primary care trust (PCT).

The framework was applied successfully and helped identify limitations and omissions in the PCT obesity management strategy.

The IC-OSAF is a practical, easy-to-use tool for the analysis of local obesity management strategies. The framework can help identify gaps and limitations in strategies to help reduce variations in obesity management between PCTs.

To establish what factors are important for patients to engage in a new intervention for chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) and make recommendations to general practitioners (GPs) on preparing a patient for referral to such a service.

NICE guidelines recommend a prominent role for primary care in the management of patients with CFS/ME, with prompt diagnosis and appropriate referral for evidence-based treatments.

A qualitative study nested within a multi-centre randomised controlled trial of two new nurse therapist delivered interventions. Semi-structured interviews carried out with 19 patients who had received pragmatic rehabilitation (PR) in the trial. Interviews were transcribed verbatim and an iterative approach used to develop themes from the data set.

Factors that influence whether or not a patient engages with PR for CFS/ME are ensuring that the patient feels accepted and believed, that they accept the diagnosis, and that the model implicated by the treatment offered to the patient matches the model of illness held by the patient. If patients hold a clearly incompatible model of their illness, it is unlikely that they will engage with, and successfully complete, therapy. It is vital that the GP elicits and explores such illness beliefs either before making a referral to maximise patient engagement in therapy, or that an initial session with the therapist explores attitudes to the treatment model offered and then works with the patient’s model.

Primary care providers and researchers wishing to estimate study recruitment rates need estimates of illness frequency in primary care. Previous studies of children’s symptoms have found that presentations are most common for the symptoms: cough, fever, earache, rash, diarrhoea and vomiting. Since 2000, primary care provision in the United Kingdom has changed with the introduction of Walk-in-Centres (WICs) and new Out of Hours (OoHs) providers.

To describe the type and frequency of parent-reported presenting symptoms at a range of primary care sites between 2005 and 2007.

Parent-reported presenting symptoms, recorded in their own words, were extracted from data collected from all children aged six months to six years during recruitment to a randomised controlled trial. Presenting symptoms were coded and presented as frequency per 100 ‘consulting sessions’ by type of primary care site.

Results were evaluated from 2491 episodes of illness at 35 sites. When grouped by primary care site, respiratory symptoms were the most common at OoHs centres, the WIC and general practitioner (GP) surgeries. Trauma symptoms were common in the Emergency Department, but unexpectedly, diarrhoea and vomiting were more common in the Emergency Department and skin presenting symptoms more common at the WIC than at GP sites.

We report the relative frequency of acute symptoms by type of primary care provider. These data may be useful to those planning recruitment to primary care paediatric studies and policy makers for planning primary care service provision.

The aim was to assess the oral health needs of homeless people in dedicated homeless dental units in London, Cardiff and Glasgow and a homeless shelter in Birmingham in order to allow recommendations for service delivery to be made for this socially excluded group.

Two questionnaires were designed, one to be completed by homeless people and the other by members of the dental team. A total of seventeen staff working in homeless dentistry completed questionnaires. Of these, nine were dentists, seven were nurses and one was a therapist. Twenty-seven homeless adults took part in interview. Of these, 22 were under active treatment at a homeless dental clinic and the remaining five were from the Birmingham homeless shelter who were not receiving dental care.

This study found evidence that the oral health of homeless adults was poor, with a high level of dental need. The service use of homeless people is low, with low levels of registration and utilisation of accident and emergency services. In terms of the most suitable method of dental treatment, staff felt a dedicated homeless service was most appropriate, whereas there was almost an equal split of patients advocating the General Dental Service or the dedicated dental clinics.

Low utilization of health and nutrition services is a major setback to the attainment of ultimate health of many populations in developing countries including Ghana. Primary health care (PHC) forms the basis for the provision of good quality and sustainable health care and making it accessible to the majority of the population. In line with this, the Catholic Relief Services spearheaded a Development Assistance Programme for the 2004–08 financial year in the northern sector of Ghana. The primary beneficiaries were children in their early years and pregnant and lactating women. The main aim of the evaluation was to assess the extent to which the programme objectives were achieved. This paper highlights the innovative processes used to improve access to and utilization of key health and nutrition services and their impact on the health of children and women.

A pre-test/post-test design involving two cross-sectional surveys at baseline and follow-up surveys were used to determine the outcome/impact of the programme.

The study findings show that the programme reduced chronic malnutrition by 1.5 percentage points/year in participating communities. The programme also empowered individuals and communities to adopt positive health behaviours (empowerment defined here as the ability to act in one’s own interest). Furthermore, the programme provided facilities and logistics, which increased access to health and nutrition services, improved the quality of health services and strengthened the institutional capacity of District Health Management teams to plan for and manage health activities.

The programme showed improvement over time in terms of health-seeking behaviours, practices and coverage of health and nutrition services from the baseline levels. If similar programme activities are put in place, the nutrition-related millennium development goals are most likely to be met.

To describe the annual consultation prevalence of different patellofemoral disorders across the adult life span.

The knee is the second most common site for musculoskeletal pain. Evidence from sports injury and orthopaedic settings suggests that patellofemoral disorders constitute a significant proportion of knee pain cases, but we have no evidence from general practice – the setting where most patellofemoral problems will present and be dealt with – of the prevalence of consultations for these problems in the different age groups.

Age- and gender-stratified annual person consulting prevalence rates (APCPRs) for patellofemoral disorders were calculated using 2006 data from the ‘Consultations in Primary Care Archive’ (CiPCA) – a fully audited database of continuous morbidity recording used by the general practitioners (GPs) in eight general practices in North Staffordshire.

A total of 57 555 >15-year-olds were registered with the eight general practices in 2006; 1782 made a knee-related consultation, of which 303 (one-in-six) were coded as patellofemoral disorders (APCPR, 53 per 10 000 persons), suggesting that GPs consider a significant proportion of adult knee pain consulters to have patellofemoral disorders. Twelve patellofemoral disorders diagnosed by the GPs were identified. The non-specific diagnosis of ‘anterior knee pain’ (AKP) was by far the most common (APCPR, 37.2/10 000). Other more specific diagnoses were rare by contrast, suggesting that specific patellofemoral disorders are rarely diagnosed in general practice (consultation prevalences, in order of most prevalent first: bursitis (7.8/10 000), patellofemoral osteoarthritis (2.3/10 000); APCPRs for the remaining nine diagnoses ranged between 0 and 1.6/10 000). However, the use of alternative less anatomically specific diagnostic codes, such as for ‘knee pain’, may mean that our estimate of one-in-six is an underestimate of GPs’ true attribution rates to patellofemoral joint disorders of people consulting them with knee pain. AKP was seen equally commonly by GPs across all age strata, contradicting the received wisdom that AKP problems are most common among younger adults.

To explore the experiences of people with advanced cancer and/or their caregivers accessing out-of-hours care.

The organisation and delivery of out-of-hours in the United Kingdom has undergone major reforms over the past three decades culminating in the new General Medical Service contract in 2004. There are concerns around continuity of care for patients with complex needs under the new arrangements.

A qualitative interview study was undertaken recruiting patients from two primary care trusts in Southwest England. Semi-structured interviews were conducted with 28 people with advanced cancer and/or their caregivers who had recently requested out-of-hours care. Interviews were recorded, transcribed and analysed thematically.

Two main themes were identified including the legitimacy of seeking help and continuities of care. Most participants were reluctant to seek help, finding it difficult to decide whether their needs were sufficient to contact services. The degree to which services legitimised participants’ requests mediated their experiences. Distress arose when services were dismissive of their needs, whereas respondents were appreciative of clinicians who provided them with reassurance. Participants reported a lack of relational and informational continuity of care. Consulting with an unfamiliar clinician out-of-hours raised doubts in some participants’ minds about the quality of care. Some participants recounted episodes in which there were problems with pain management. While the themes suggest that the delivery of out-of-hours care as a whole was not always perfect, around-the-clock access to professional sources of support and reassurance was highly valued. However, the transfer of information to out-of-hours providers remains a key challenge; participants did not understand why out-of-hours providers could not access more information on their medical histories given the level of computerisation within the National Health Service. The findings highlight the need to improve continuity between in-hours and out-of-hours services for patients with complex needs.

Although mental illness remains the leading cause of both sickness absence and incapacity benefit in most high-income countries, little is known about how frequently patients with mental ill-health receive sickness certificates and what conditions are most commonly certified for. This study aims to use general practice consultation data to determine the rate of sickness certification for common mental health problems.

Analysis of a general practice consultation database rates of certification are presented for people consulting with a mental health problem, along with the proportion of these consultations in which a certificate was issued.

The highest rates of certification among those consulting with mental health problems occurred for depression, stress-related problems and bereavement. Almost two-thirds of the consultations for bereavement resulted in a sickness certificate being issued. At least one in three mental health consultations resulted in a sickness certificate being issued.

Consultation for mental health problems in primary care frequently results in the issuing of a sickness certificate. Further study is urgently needed to provide adequate support systems to enable patients to return to work whenever possible.